Provider Demographics
NPI:1215928023
Name:OWENS-LANE, JANICE (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:OWENS-LANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 WASHINGTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3025
Mailing Address - Country:US
Mailing Address - Phone:203-288-9666
Mailing Address - Fax:203-288-0344
Practice Address - Street 1:295 WASHINGTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3025
Practice Address - Country:US
Practice Address - Phone:203-288-9666
Practice Address - Fax:203-288-0344
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001870103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R56667Medicare UPIN