Provider Demographics
NPI:1609038892
Name:LANG, WENDY JILL
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JILL
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:JILL
Other - Last Name:KAPLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11518-2218
Mailing Address - Country:US
Mailing Address - Phone:516-946-5497
Mailing Address - Fax:
Practice Address - Street 1:3 WALNUT RD
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-2218
Practice Address - Country:US
Practice Address - Phone:516-946-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR069904-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR069904-1OtherOFFICE OF PROFESSIONS, NEW YORK STATE