Individual
MR. BRIAN GARRETT LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
699 BLOOMFIELD AVE, BLOOMFIELD, CT 06002-2462
(860) 392-9990
(860) 243-6591
Mailing address
699 BLOOMFIELD AVE, BLOOMFIELD, CT 06002-2462
(860) 392-9990
(860) 243-6591
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6808
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WSW22474B
MEDICARE PPIN
CA
Enumeration date
11/09/2006
Last updated
07/31/2015
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