Provider Demographics
NPI:1811015126
Name:LANGKOPF, PATTY (LCSW)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:LANGKOPF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 MOUNTFORT RD
Mailing Address - Street 2:
Mailing Address - City:NORTH YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04097-6919
Mailing Address - Country:US
Mailing Address - Phone:207-846-8907
Mailing Address - Fax:
Practice Address - Street 1:45 FOREST FALLS DR
Practice Address - Street 2:SUITE #2
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6999
Practice Address - Country:US
Practice Address - Phone:207-939-9763
Practice Address - Fax:207-846-7756
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC36801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0024919OtherMEDICARE PTAN