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Individual

DR. CARISSA MARIE LANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
3900 WOODLAND AVE, PHILADELPHIA, PA 19104-4551
(215) 823-5800
Mailing address
2112 SOUTH ST APT 4, PHILADELPHIA, PA 19146-1267
(515) 943-6073

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS019580
PA

Other

Enumeration date
10/14/2022
Last updated
10/14/2022
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