Provider Demographics
NPI:1457671232
Name:LANGE, ADRIANNE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADRIANNE
Middle Name:ELIZABETH
Last Name:LANGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 NORRIS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1227
Mailing Address - Country:US
Mailing Address - Phone:646-236-7445
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1190 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1712
Practice Address - Country:US
Practice Address - Phone:502-309-2408
Practice Address - Fax:502-771-4283
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
KY242609103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01887352OtherRR MEDICARE
KY7100482680Medicaid
IN300006191Medicaid
KYK249650OtherMEDICARE