Provider Demographics
NPI:1366510117
Name:LANE, CHARLENE (PHD,LCSWR)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:PHD,LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CRUMS MILLS ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112
Mailing Address - Country:US
Mailing Address - Phone:347-768-3662
Mailing Address - Fax:
Practice Address - Street 1:420 CRUMS MILL ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:347-768-3662
Practice Address - Fax:516-872-1138
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0190091041C0700X
NYR050052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health