Provider Demographics
NPI:1609991470
Name:LANGE, RICHARD THEODORE JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:THEODORE
Last Name:LANGE
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KAUFFMAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3210
Mailing Address - Country:US
Mailing Address - Phone:215-463-1829
Mailing Address - Fax:
Practice Address - Street 1:108 SOMERDALE RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1901
Practice Address - Country:US
Practice Address - Phone:856-428-5688
Practice Address - Fax:856-795-4094
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00241100101YP2500X
NJ44SC052508001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00166363300OtherINDEPENDENCE BC BC
NJ2321500000OtherAMERIHEALTH PPO
NJ7119413OtherAETNA BEHAVIORAL HEALTH