Active NPI
Brian Thomas Lane, LPC
- Professional Counselor
- Waldwick, NJ
National Provider Identifier
1720103880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- PC739
- Practice address
- 40 Bergen Ave
Waldwick, NJ 07463-1936 - Phone
- (201) 410-7699
- NPI assigned
- Mar 20, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC739 | NJ | Primary |
Addresses
Primary practice location
40 Bergen Ave
Waldwick, NJ 07463-1936
Mailing address
40 Bergen Ave
Waldwick, NJ 07463-1936
Phone (201) 410-7699
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC739 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720103880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 BERGEN AVE",
"city": "WALDWICK",
"state": "NJ",
"postal_code": "074631936",
"telephone_number": "201-410-7699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 BERGEN AVE",
"city": "WALDWICK",
"state": "NJ",
"postal_code": "074631936",
"telephone_number": "201-410-7699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "BRIAN",
"middle_name": "THOMAS",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "PC739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waldwick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.