MEDICARE: MS. LASONIA LANG

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
1	101Y00000X	Counselor	S93221921	MA

General Provider Information

NPI Number	:	1558671149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LASONIA LANG

Provider Business Mailing Address
First Line	:	64 WASHINGTON ST
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-3328
Country	:	US
Telephone Number	:	857-544-3896
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 WASHINGTON ST
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-3328
Country	:	US
Telephone Number	:	857-544-3896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2010
Last Update Date	:	01/24/2011

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