Provider Demographics
NPI:1598809121
Name:LANG, BONNIE DENTON (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:DENTON
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 1:3 MYSTIC CT
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2920
Mailing Address - Country:US
Mailing Address - Phone:631-751-0058
Mailing Address - Fax:
Practice Address - Street 1:3 MYSTIC CT
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2920
Practice Address - Country:US
Practice Address - Phone:631-751-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0195171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080958OtherVALUE OPTIONS
NY080958OtherVALUE OPTIONS