Provider Demographics
NPI:1659476638
Name:DIANE LANGBERG PHD & MARTHA D LANGBERG ASSOCIATES
Entity Type:Organization
Organization Name:DIANE LANGBERG PHD & MARTHA D LANGBERG ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:LANGBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-885-1835
Mailing Address - Street 1:512 WEST AVENUE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046
Mailing Address - Country:US
Mailing Address - Phone:215-885-1835
Mailing Address - Fax:215-885-8510
Practice Address - Street 1:512 WEST AVENUE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-885-1835
Practice Address - Fax:215-885-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002729LOWNERDIRECT103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA877160OtherHIGHMARK BLUE SHIELD