Healthcare Provider Details

I. General information

NPI: 1134674625
Provider Name (Legal Business Name): LAKISHA LANGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SCIENCE PARK FLOOR 2
NEW HAVEN CT
06511-1966
US

IV. Provider business mailing address

228 HOMESIDE AVE
WEST HAVEN CT
06516-2460
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-8648
  • Fax:
Mailing address:
  • Phone: 203-668-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: