Provider Demographics
NPI:1265846851
Name:LANGSAM, AMY (PSYD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:LANGSAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 RIDGE AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1647
Mailing Address - Country:US
Mailing Address - Phone:267-229-7501
Mailing Address - Fax:
Practice Address - Street 1:6060 RIDGE AVE
Practice Address - Street 2:FL 2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1647
Practice Address - Country:US
Practice Address - Phone:267-229-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017466103TC0700X
NJ35S100527500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical