Provider Demographics
NPI:1770893166
Name:LANGFORD, JAIME ELLEN
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ELLEN
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VANDERHOOF AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3148
Mailing Address - Country:US
Mailing Address - Phone:973-586-5243
Mailing Address - Fax:
Practice Address - Street 1:20 VANDERHOOF AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3148
Practice Address - Country:US
Practice Address - Phone:973-586-5243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-19
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056075001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00745088OtherAGENCY MEDICAID MMIS #
NY1003991019OtherAGENCY NPI #