1194795179 NPI number — MARLENE LANE M.S., CCC-A/ FAAA

Table of content: MARLENE LANE M.S., CCC-A/ FAAA (NPI 1194795179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194795179 NPI number — MARLENE LANE M.S., CCC-A/ FAAA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
MARLENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-A/ FAAA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194795179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 WORCESTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLESLEY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481-5420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-431-5275
Provider Business Mailing Address Fax Number:
871-431-5583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 WORCESTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLESLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02481-5420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-431-5275
Provider Business Practice Location Address Fax Number:
871-431-5583
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  679 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0022337 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AD0162 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PJ221 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5100992 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: B501027 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00202525 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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