Provider Demographics
NPI:1598119430
Name:LANG, ELIZABETH ANN (MED BCBA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:LANG
Suffix:
Gender:F
Credentials:MED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S 3RD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2150
Mailing Address - Country:US
Mailing Address - Phone:484-935-1111
Mailing Address - Fax:
Practice Address - Street 1:202 S 3RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2150
Practice Address - Country:US
Practice Address - Phone:484-935-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst