Provider Demographics
NPI:1629569405
Name:LANGE, SHIORI KOGA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHIORI
Middle Name:KOGA
Last Name:LANGE
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 1:6615 E PACIFIC COAST HWY STE 225
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4216
Mailing Address - Country:US
Mailing Address - Phone:424-241-2378
Mailing Address - Fax:
Practice Address - Street 1:6615 E PACIFIC COAST HWY STE 225
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803
Practice Address - Country:US
Practice Address - Phone:424-241-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA817301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical