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NPI Code Detail

MEDICARE: DR. MARY JOANN LANG PHD, ABPB, BCBA

MEDICARE: DR. MARY JOANN LANG PHD, ABPB, BCBA
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
1103G00000XClinical Neuropsychologist
2103TC0700XClinical Psychologist12076CA

General Provider Information

NPI Number : 1083881148
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY JOANN LANG PHD, ABPB, BCBA
Provider Business Mailing Address
First Line : 588 N GLASSELL ST
Second Line :
City : ORANGE
State : CA
Zip : 92867-6748
Country : US
Telephone Number : 714-288-4200
Fax Number : 714-288-4204
Provider Business Practice Location Address
First Line : 588 N GLASSELL ST
Second Line :
City : ORANGE
State : CA
Zip : 92867-6748
Country : US
Telephone Number : 714-288-4200
Fax Number : 714-288-4204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2008
Last Update Date : 05/08/2008

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