| Doctor Name: | MS. MICHELLE DENISE LANE |
| NPI Number: | 1053473538 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, LCSW |
| License Number: | 44SC04734800 |
| Business Practice Address: | 130 Powerville Rd Mica Outpatient Services , Saint Clares Hospital Boonton, NJ - 070058705 |
| Business Phone Number: | 9733161894 |
| Business Fax Number: | 9733161882 |
| Mailing Address: | Po Box 276, BOONTON |
| State: | NJ |
| Postal Code: | 070050276 |
| Phone Number: | 9734797479 |
| Fax Number: | 9733161882 |
| NPI Enumeration Date: | 12/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC04734800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |