Healthcare Provider Details

I. General information

NPI: 1457671232
Provider Name (Legal Business Name): ADRIANNE ELIZABETH LANGE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 E BROADWAY
LOUISVILLE KY
40204-1712
US

IV. Provider business mailing address

1607 NORRIS PL
LOUISVILLE KY
40205-1227
US

V. Phone/Fax

Practice location:
  • Phone: 502-309-2408
  • Fax: 502-771-4283
Mailing address:
  • Phone: 646-236-7445
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number242609
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: