Basic Information
| Provider Information | |||||||||
| NPI: | 1154553287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANGER | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LSP, BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2780 VERANDAH VUE WAY | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338126392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8639440841 | ||||||||
| FaxNumber: | 8636449590 | ||||||||
| Practice Location | |||||||||
| Address1: | 2780 VERANDAH VUE WAY | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338126392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8639440841 | ||||||||
| FaxNumber: | 8636449590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2009 | ||||||||
| LastUpdateDate: | 08/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-07-3242 | FL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 103TS0200X | SS739 | FL | N | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.