Provider Demographics
NPI:1114174323
Name:LANG, FAITH SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:SUSAN
Last Name:LANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 ROUTE 211 E STE 7
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-3100
Mailing Address - Country:US
Mailing Address - Phone:845-341-8493
Mailing Address - Fax:845-343-2501
Practice Address - Street 1:280 ROUTE 211 E STE 7
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3100
Practice Address - Country:US
Practice Address - Phone:845-341-8493
Practice Address - Fax:845-258-4611
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW165401041C0700X
NY078115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty