Provider Demographics
NPI:1518641224
Name:LANGE, NICHOLAS ANTHONY (MA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:LANGE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:125 EMERYVILLE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5020
Mailing Address - Country:US
Mailing Address - Phone:724-609-5002
Mailing Address - Fax:
Practice Address - Street 1:1910 COCHRAN ROAD, MANOR OAK 2, SUITE 325
Practice Address - Street 2:
Practice Address - City:MT. LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15220
Practice Address - Country:US
Practice Address - Phone:724-609-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional