Active NPI
Kelly Beakley Lane, PSY.D.
- Clinical Child & Adolescent Psychologist
- Easton, MD
National Provider Identifier
1861745440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 05234
- Practice address
- 111 N West St Ste H
Easton, MD 21601-2760 - Phone
- (410) 443-5527
- NPI assigned
- Oct 19, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 05234 | MD | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 05234 | MD | Primary |
Addresses
Primary practice location
111 N West St Ste H
Easton, MD 21601-2760
Mailing address
111 N West St Ste H
Easton, MD 21601-2760
Phone (410) 443-5527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150827002798 | MD | Practitioner - Clinical Psychologist | 0840504536 | Practice locations: Easton, MD |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Philadelphia College of Osteopathic Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
133 N W St
Suite H
Easton, MD 21601-9920
Phone (410) 443-5527
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05234 | MD | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1861745440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 N WEST ST STE H",
"city": "EASTON",
"state": "MD",
"postal_code": "216012760",
"telephone_number": "410-443-5527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 N WEST ST STE H",
"city": "EASTON",
"state": "MD",
"postal_code": "216012760",
"telephone_number": "410-443-5527"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "KELLY",
"middle_name": "BEAKLEY",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-19",
"last_updated": "2022-07-21",
"certification_date": "2021-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "05234",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "MD",
"license": "05234",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Easton, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.