Provider Demographics
NPI:1104058569
Name:LANE, ALEXANDER BAILEY (LCSW)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:BAILEY
Last Name:LANE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 W SHADY LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2052
Mailing Address - Country:US
Mailing Address - Phone:207-347-9904
Mailing Address - Fax:
Practice Address - Street 1:2033 E EDGEWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3660
Practice Address - Country:US
Practice Address - Phone:638-606-8097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-19
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW142321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty