Healthcare Provider Details

I. General information

NPI: 1700076130
Provider Name (Legal Business Name): LAURIE RUTH LANGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 BONANZA ST
WALNUT CREEK CA
94596-4317
US

IV. Provider business mailing address

292 RIVIERA CIR
LARKSPUR CA
94939-1507
US

V. Phone/Fax

Practice location:
  • Phone: 925-946-1622
  • Fax: 415-563-1600
Mailing address:
  • Phone: 925-946-1622
  • Fax: 415-563-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: