Provider Demographics
NPI:1689675290
Name:LANG, MARK T (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:T
Last Name:LANG
Suffix:
Gender:M
Credentials:LCSW
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Mailing Address - Street 1:2699 STIRLING RD
Mailing Address - Street 2:SUITE C-304
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6517
Mailing Address - Country:US
Mailing Address - Phone:954-893-7110
Mailing Address - Fax:954-893-1105
Practice Address - Street 1:2699 STIRLING RD
Practice Address - Street 2:SUITE C-304
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6517
Practice Address - Country:US
Practice Address - Phone:954-893-7110
Practice Address - Fax:954-893-1105
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2014-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLSW34921041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6790Medicare ID - Type UnspecifiedL.C.S.W.