Provider Demographics
NPI:1629086186
Name:LANG, RAYMOND THOMAS JR (LISW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:THOMAS
Last Name:LANG
Suffix:JR
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 SOUTH EISENHOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-1562
Mailing Address - Country:US
Mailing Address - Phone:641-424-2075
Mailing Address - Fax:641-424-9555
Practice Address - Street 1:235 SOUTH EISENHOWER
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1562
Practice Address - Country:US
Practice Address - Phone:641-424-2075
Practice Address - Fax:641-424-9555
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00825104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
08983Medicare PIN