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NPI Code Detail

MEDICARE: MR. MARK T LANG L.C.S.W.

MEDICARE:  MR. MARK T LANG  L.C.S.W.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerSW3492FL

General Provider Information

NPI Number : 1689675290
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK T LANG L.C.S.W.
Provider Business Mailing Address
First Line : 2699 STIRLING RD
Second Line : SUITE C-304
City : FORT LAUDERDALE
State : FL
Zip : 33312-6517
Country : US
Telephone Number : 954-893-7110
Fax Number : 954-893-1105
Provider Business Practice Location Address
First Line : 2699 STIRLING RD
Second Line : SUITE C-304
City : FORT LAUDERDALE
State : FL
Zip : 33312-6517
Country : US
Telephone Number : 954-893-7110
Fax Number : 954-893-1105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2005
Last Update Date : 03/04/2014

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Directions to “ MR. MARK T LANG L.C.S.W.” Practice Location

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