Provider Demographics
NPI:1467468512
Name:ROSE-LANGSTON, JASON AARON (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:AARON
Last Name:ROSE-LANGSTON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 PLEASANT ST
Mailing Address - Street 2:SUITE # 316
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2752
Mailing Address - Country:US
Mailing Address - Phone:413-695-6633
Mailing Address - Fax:413-604-0203
Practice Address - Street 1:116 PLEASANT ST
Practice Address - Street 2:SUITE # 316
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2752
Practice Address - Country:US
Practice Address - Phone:413-695-6633
Practice Address - Fax:413-604-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1119301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23435Medicare ID - Type Unspecified