1184969834 NPI number — WESLEIGH LANGELAND MCMAHON LICSW

Table of content: WESLEIGH LANGELAND MCMAHON LICSW (NPI 1184969834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184969834 NPI number — WESLEIGH LANGELAND MCMAHON LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMAHON
Provider First Name:
WESLEIGH
Provider Middle Name:
LANGELAND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LANGELAND
Provider Other First Name:
WESLEIGH
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184969834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 MILL ST
Provider Second Line Business Mailing Address:
MCLEAN HOSPITAL CHILD OUTPATIENT DEPARTMENT
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02478-1064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-855-3237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MILL ST
Provider Second Line Business Practice Location Address:
MCLEAN HOSPITAL CHILD OUTPATIENT DEPARTMENT
Provider Business Practice Location Address City Name:
BELMONT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02478-1064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-855-3237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  116820 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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