Provider Demographics
NPI:1649375627
Name:LANGBERG, MARTHA DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DIANE
Last Name:LANGBERG
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 1:512 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002729L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA29603OtherHIGHMARK BLUE SHIELD PREM
PA29603OtherHIGHMARK BLUE SHIELD PREM