Provider Demographics
NPI:1497846547
Name:LANGDALE, LYNN (MA)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:
Last Name:LANGDALE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:LANGDALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA, MA
Mailing Address - Street 1:5450 MACDONALD AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040
Mailing Address - Country:US
Mailing Address - Phone:305-294-1277
Mailing Address - Fax:305-294-8927
Practice Address - Street 1:5450 MACDONALD AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040
Practice Address - Country:US
Practice Address - Phone:305-294-1277
Practice Address - Fax:305-294-8927
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ2232Medicare UPIN