Provider Demographics
NPI:1972102234
Name:WANG LANTERMAN, XIAOFANG (PHD, MA, MS, LGMFT)
Entity type:Individual
Prefix:DR
First Name:XIAOFANG
Middle Name:
Last Name:WANG LANTERMAN
Suffix:
Gender:F
Credentials:PHD, MA, MS, LGMFT
Other - Prefix:DR
Other - First Name:XIAOFANG (BETHANIE)
Other - Middle Name:
Other - Last Name:WANG LANTERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, MA, MS, LGMFT
Mailing Address - Street 1:5113 MINEOLA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4609
Mailing Address - Country:US
Mailing Address - Phone:301-338-8398
Mailing Address - Fax:
Practice Address - Street 1:6203 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3906
Practice Address - Country:US
Practice Address - Phone:240-222-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDLGM788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFQ42-0000OtherCAREFIRST BCBS