Provider Demographics
NPI:1154553287
Name:SANGER, KEVIN (LSP, BCBA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:SANGER
Suffix:
Gender:M
Credentials:LSP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 VERANDAH VUE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-6392
Mailing Address - Country:US
Mailing Address - Phone:863-944-0841
Mailing Address - Fax:863-644-9590
Practice Address - Street 1:2780 VERANDAH VUE WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-6392
Practice Address - Country:US
Practice Address - Phone:863-944-0841
Practice Address - Fax:863-644-9590
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-07-3242103K00000X
FLSS739103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool