Provider Demographics
NPI:1598168890
Name:LANG, JESSE TYLER (LCSW)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:TYLER
Last Name:LANG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3855
Mailing Address - Country:US
Mailing Address - Phone:508-790-3360
Mailing Address - Fax:508-790-3366
Practice Address - Street 1:460 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3855
Practice Address - Country:US
Practice Address - Phone:508-790-3360
Practice Address - Fax:508-790-3366
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2311571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical