Individual provider Active NPI

Liam R Lane, LICSW, LADC-I

  • Clinical Social Worker
  • Quincy, MA
National Provider Identifier
1497366686
Registry record updated Feb 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
126828 Issued in MA
Practice address
859 Willard St Ste 400
Quincy, MA 02169-7469
Phone
(617) 999-5715
Fax
(401) 489-7898
NPI assigned
Aug 12, 2020
Last updated
Feb 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X
Addiction (Substance Use Disorder) Counselor 101YA0400X 14701 MA
Clinical Social Worker 1041C0700X
Clinical Social Worker 1041C0700X 126828 MA Primary

Addresses

Primary practice location

859 Willard St Ste 400
Quincy, MA 02169-7469

Mailing address

859 Willard St Ste 400
Quincy, MA 02169-7469
Phone (617) 999-5715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250203001459 MA Practitioner - Clinical Social Worker 2860921046 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14701MAMDAddiction (Substance Use Disorder) Counselor
126828MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
PDF Counseling PLLC Clinical Current Accepting new patients
PDF Assessments LLC Clinical CurrentSince Dec 7, 2024 Accepting new patients

Locations

859 Willard St
Ste 400
Quincy, MA 02169
Phone (617) 276-3067

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739836800000",
    "number": "1497366686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 WILLARD ST STE 400",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021697469",
            "telephone_number": "617-999-5715",
            "fax_number": "401-489-7898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 WILLARD ST STE 400",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021697469",
            "telephone_number": "617-999-5715",
            "fax_number": "401-489-7898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "LIAM",
        "middle_name": "R",
        "credential": "LICSW, LADC-I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-12",
        "last_updated": "2025-02-18",
        "certification_date": "2025-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MA",
            "license": "14701",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "126828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

Verify at the official NPI Registry.