MEDICARE: AMY LANGSAM PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS017466	PA
2	103TC0700X	Clinical Psychologist	35S100527500	NJ

General Provider Information

NPI Number	:	1265846851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LANGSAM PSY.D.

Provider Business Mailing Address
First Line	:	6060 RIDGE AVE
Second Line	:	FL 2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1647
Country	:	US
Telephone Number	:	267-229-7501
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 RIDGE AVE
Second Line	:	FL 2
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1647
Country	:	US
Telephone Number	:	267-229-7501
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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