Provider Demographics
NPI:1174631568
Name:LANGEVIN, CATHERINE FAYE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:FAYE
Last Name:LANGEVIN
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 1:30978 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612-2160
Mailing Address - Country:US
Mailing Address - Phone:207-838-2943
Mailing Address - Fax:
Practice Address - Street 1:30978 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:BLACK RIVER
Practice Address - State:NY
Practice Address - Zip Code:13612-2160
Practice Address - Country:US
Practice Address - Phone:207-838-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC48981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME025940OtherBLUE CROSS BLUE SHIELD
ME025940OtherBLUE CROSS BLUE SHIELD