Provider Demographics
NPI:1811478894
Name:LANG, TAMA (LICSW)
Entity type:Individual
Prefix:
First Name:TAMA
Middle Name:
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 1:135 LITWIN LN
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4892
Mailing Address - Country:US
Mailing Address - Phone:413-594-3545
Mailing Address - Fax:413-594-3547
Practice Address - Street 1:135 LITWIN LN
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-4892
Practice Address - Country:US
Practice Address - Phone:413-594-3545
Practice Address - Fax:413-594-3547
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty