Provider Demographics
NPI:1871586404
Name:LANG, KATHLEEN-JANE T SHORTALL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN-JANE
Middle Name:T SHORTALL
Last Name:LANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 EUSTON RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5303
Mailing Address - Country:US
Mailing Address - Phone:516-485-0709
Mailing Address - Fax:
Practice Address - Street 1:381 EUSTON RD S
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5303
Practice Address - Country:US
Practice Address - Phone:516-485-0709
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03763311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N55721Medicare ID - Type Unspecified