Individual
AMY LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
612 S MYRTLE AVE, MONROVIA, CA 91016-3406
(800) 207-0272
Mailing address
612 S MYRTLE AVE, MONROVIA, CA 91016-3406
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-15-18558
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-18558
BCBA LICENSE
CA
Enumeration date
12/19/2016
Last updated
02/26/2024
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