Provider Demographics
NPI:1306632138
Name:LANE, COURTNEY (RCSWI)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8210 FLORIDA DR APT 228
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4568
Mailing Address - Country:US
Mailing Address - Phone:561-768-8480
Mailing Address - Fax:
Practice Address - Street 1:8210 FLORIDA DR APT 228
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4568
Practice Address - Country:US
Practice Address - Phone:561-768-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20833104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker