Provider Demographics
NPI:1942530886
Name:LANGE, PAULA COLLEEN (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:COLLEEN
Last Name:LANGE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9378 S MASON MONTGOMERY RD # 378
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8827
Mailing Address - Country:US
Mailing Address - Phone:513-904-9322
Mailing Address - Fax:844-740-0064
Practice Address - Street 1:9378 S MASON MONTGOMERY RD # 378
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8827
Practice Address - Country:US
Practice Address - Phone:513-904-3222
Practice Address - Fax:844-740-0064
Is Sole Proprietor?:No
Enumeration Date:2009-12-26
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14511401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188163Medicaid