Healthcare Provider Details

I. General information

NPI: 1174321806
Provider Name (Legal Business Name): CHELSEA LANG PMHNP-BC, APRN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 JAY ST STE 501
BROOKLYN NY
11201-4398
US

IV. Provider business mailing address

203 JAY ST STE 501
BROOKLYN NY
11201-4398
US

V. Phone/Fax

Practice location:
  • Phone: 347-304-9465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406942
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number776260
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9605082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: