Provider Demographics
NPI:1477750628
Name:LANGMORE, JEAN ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ELIZABETH
Last Name:LANGMORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22431 ANTONIO PKWY STE B160
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3932
Mailing Address - Country:US
Mailing Address - Phone:949-444-8647
Mailing Address - Fax:
Practice Address - Street 1:22431 ANTONIO PKWY STE B160
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3932
Practice Address - Country:US
Practice Address - Phone:949-444-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17141103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist