Healthcare Provider Details

I. General information

NPI: 1275929903
Provider Name (Legal Business Name): KANE LOVERIDGE PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S MEMORIAL DR SUITE I
NEW CASTLE IN
47362-1272
US

IV. Provider business mailing address

3900 S MEMORIAL DR STE A
NEW CASTLE IN
47362-1307
US

V. Phone/Fax

Practice location:
  • Phone: 765-465-3387
  • Fax: 888-441-0850
Mailing address:
  • Phone: 765-388-2671
  • Fax: 888-441-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20042765A
License Number StateIN

VIII. Authorized Official

Name: DR. ERICA D KANE
Title or Position: OWNER
Credential: PSYD, HSPP
Phone: 765-388-2671