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Individual
MARK LANE
Active
Individual
MARK LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
123343
MA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
03/11/2013
Last updated
04/27/2022
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