Provider Demographics
NPI:1306991047
Name:LANE, JANE A (LCSW)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:LANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WILLIAM DONNELLY INDUS PKWY
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1500
Mailing Address - Country:US
Mailing Address - Phone:607-565-9594
Mailing Address - Fax:607-565-7194
Practice Address - Street 1:80 WILLIAM DONNELLY PARKWAY
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892
Practice Address - Country:US
Practice Address - Phone:607-565-9594
Practice Address - Fax:607-565-7194
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026217-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00618162Medicaid
NYR026217-1OtherLCSW LICENSE NUMBER
OTH000Medicare UPIN
NY39062AMedicare ID - Type UnspecifiedEMPLOYER MEDICARE NUMBER
NY00618162Medicaid