Provider Demographics
NPI:1134380967
Name:LANGMADE, CALVIN JAY (PSYD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:JAY
Last Name:LANGMADE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17100 W NORTH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4436
Mailing Address - Country:US
Mailing Address - Phone:262-789-1818
Mailing Address - Fax:262-789-5355
Practice Address - Street 1:17100 W NORTH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4436
Practice Address - Country:US
Practice Address - Phone:262-789-1818
Practice Address - Fax:262-789-5355
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1054-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist