Healthcare Provider Details

I. General information

NPI: 1336597590
Provider Name (Legal Business Name): SANDRA K LANGE PSY. D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2016
Last Update Date: 05/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6795
US

IV. Provider business mailing address

3911 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6795
US

V. Phone/Fax

Practice location:
  • Phone: 954-639-7345
  • Fax: 954-639-7433
Mailing address:
  • Phone: 954-639-7345
  • Fax: 954-639-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: