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General NPI Number Information
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NPI Number | 1457671232
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Entity Type | Individual
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Provider Name | ADRIANNE ELIZABETH LANGE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 1190 E BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40204-1712
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Country | US
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Telephone | 502-309-2408
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Fax | 502-771-4283
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Provider Business Mailing Address
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Address Line | 1607 NORRIS PL
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City | LOUISVILLE
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State | KY
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Zip | 40205-1227
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Country | US
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Telephone | 646-236-7445
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Fax | --
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 242609
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License Number State | KY
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