Provider Demographics
NPI:1942372313
Name:LANG, ELIZABETH SHIRLEY (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SHIRLEY
Last Name:LANG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WING TER
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1919
Mailing Address - Country:US
Mailing Address - Phone:781-654-5320
Mailing Address - Fax:
Practice Address - Street 1:338 MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-5013
Practice Address - Country:US
Practice Address - Phone:781-246-2010
Practice Address - Fax:781-246-1448
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1108141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical