Provider Demographics
NPI:1346275708
Name:CHANG, LORI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14955 STERLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-4104
Mailing Address - Country:US
Mailing Address - Phone:239-985-4086
Mailing Address - Fax:239-403-8881
Practice Address - Street 1:27499 RIVERVIEW CENTER BLVD
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4313
Practice Address - Country:US
Practice Address - Phone:239-403-8883
Practice Address - Fax:239-403-8883
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54741Medicare NSC