Provider Demographics
NPI:1215228309
Name:LANG, MICHELLE A (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
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 1:101 W 12TH ST APT 15T
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8129
Mailing Address - Country:US
Mailing Address - Phone:845-649-6520
Mailing Address - Fax:
Practice Address - Street 1:325 N END AVE
Practice Address - Street 2:APT. 16-Q
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282-1026
Practice Address - Country:US
Practice Address - Phone:212-273-6238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083032104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker