Healthcare Provider Details

I. General information

NPI: 1033097514
Provider Name (Legal Business Name): KYLIE LANG LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLE LANG

II. Dates (important events)

Enumeration Date: 08/23/2025
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 PITTSFORD VICTOR RD STE 250
PITTSFORD NY
14534-3809
US

IV. Provider business mailing address

12 MEADOWBROOK DR
CANASERAGA NY
14822-9743
US

V. Phone/Fax

Practice location:
  • Phone: 585-430-9877
  • Fax: 585-200-3215
Mailing address:
  • Phone: 240-551-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number003171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: