Provider Demographics
NPI:1013470483
Name:SANGER AND ASSOCIATES - BEHAVIORAL AND PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:SANGER AND ASSOCIATES - BEHAVIORAL AND PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGER
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, LSP, BCBA
Authorized Official - Phone:863-944-0841
Mailing Address - Street 1:2780 VERANDAH VUE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812
Mailing Address - Country:US
Mailing Address - Phone:863-944-0841
Mailing Address - Fax:863-583-0480
Practice Address - Street 1:2780 VERANDAH VUE WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812
Practice Address - Country:US
Practice Address - Phone:863-944-0841
Practice Address - Fax:863-583-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019170500Medicaid