Individual
JASON LANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
65 KANE ST, UCHC DEPT. OF PSYCHIATRY, WEST HARTFORD, CT 06119-2110
(860) 523-6449
(860) 523-3736
Mailing address
270 FARMINGTON AVE, CHDI, SUITE 367, FARMINGTON, CT 06032-1909
(860) 679-1550
(860) 679-1521
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
002815
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578750576
—
CT
Enumeration date
10/03/2007
Last updated
12/28/2010
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