Organization
AMY LANE APRN, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY MICHELLE LANE APRN (APRN)
(860) 823-0245
Entity
Organization
Contact information
Practice address
410 SALEM TPKE, BOZRAH, CT 06334-1519
(860) 823-0245
(860) 213-8350
Mailing address
410 SALEM TPKE, BOZRAH, CT 06334-1519
(860) 823-0245
(860) 213-8350
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
002158
CT
261QM0850X
Adult Mental Health Clinic/Center
002158
CT
261QM0855X
Adolescent and Children Mental Health Clinic/Center
002158
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
12/13/2013
Last updated
04/02/2014
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