Provider Demographics
NPI:1275929903
Name:KANE LOVERIDGE PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:KANE LOVERIDGE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:KANE LOVERIDGE WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, HSPP
Authorized Official - Phone:765-388-2671
Mailing Address - Street 1:3900 S MEMORIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-1307
Mailing Address - Country:US
Mailing Address - Phone:765-388-2671
Mailing Address - Fax:888-441-0850
Practice Address - Street 1:2020 S MEMORIAL DR
Practice Address - Street 2:SUITE I
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1272
Practice Address - Country:US
Practice Address - Phone:765-465-3387
Practice Address - Fax:888-441-0850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042765A103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty