Provider Demographics
NPI:1366727034
Name:ERIC J LANE PSY D PA
Entity type:Organization
Organization Name:ERIC J LANE PSY D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:443-280-2916
Mailing Address - Street 1:1104 KENILWORTH DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2101
Mailing Address - Country:US
Mailing Address - Phone:443-280-2916
Mailing Address - Fax:410-377-4844
Practice Address - Street 1:1104 KENILWORTH DR
Practice Address - Street 2:SUITE 302
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2101
Practice Address - Country:US
Practice Address - Phone:443-280-2916
Practice Address - Fax:410-377-4844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04531261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)