MEDICARE: KANE LOVERIDGE PSYCHOLOGICAL SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TH0100X	Health Service Psychologist	20042765A	IN

General Provider Information

NPI Number	:	1275929903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KANE LOVERIDGE PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	3900 S MEMORIAL DR STE A
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-1307
Country	:	US
Telephone Number	:	765-388-2671
Fax Number	:	888-441-0850

Provider Business Practice Location Address
First Line	:	2020 S MEMORIAL DR
Second Line	:	SUITE I
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-1272
Country	:	US
Telephone Number	:	765-465-3387
Fax Number	:	888-441-0850

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ERICA D KANE
Credential	:	PSYD, HSPP
Telephone Number	:	765-388-2671

Provider Enumeration Date	:	04/09/2015
Last Update Date	:	08/10/2016

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