Provider Demographics
NPI:1891595922
Name:LANE, CASEY SHEA (CSW)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:SHEA
Last Name:LANE
Suffix:
Gender:
Credentials:CSW
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:SHEA
Other - Last Name:KOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:154 INDIAN SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-8925
Mailing Address - Country:US
Mailing Address - Phone:859-469-0792
Mailing Address - Fax:
Practice Address - Street 1:154 INDIAN SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-8925
Practice Address - Country:US
Practice Address - Phone:859-469-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY259864104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker