Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003109083 |
---|---|
Provider Name | Mrs. Jeniffer Lynn Lang |
First Address | Albuquerque, NM 87123-4120 |
Second Address | Albuquerque, NM 87110-4659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2011 |
Last Update Date | 02/08/2011 |