Provider Demographics
NPI:1902802960
Name:LANGUIRAND, MARY A (PH D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:LANGUIRAND
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CHOIR LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5733
Mailing Address - Country:US
Mailing Address - Phone:516-279-7406
Mailing Address - Fax:
Practice Address - Street 1:821 FRANKLIN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4519
Practice Address - Country:US
Practice Address - Phone:516-294-2790
Practice Address - Fax:516-294-2791
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD002343103TC0700X
NY011208103TC0700X
PAPS-005601-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02752770Medicaid
PA005104OtherHEALTHAMERICA PA
NY2163392OtherCIGNA BEHAVIORAL HEALTH
PAP00007427OtherPALMETTO RAILROAD
NY232859852OtherEMPLOYER
PAP00007427OtherPALMETTO RAILROAD
NY02752770Medicaid