Basic Information
| Provider Information | |||||||||
| NPI: | 1871825851 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANGLOIS | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9666 BUSINESSPARK AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921311646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196020726 | ||||||||
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| Practice Location | |||||||||
| Address1: | 587 MIDDLE TPKE E | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060403731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606463888 | ||||||||
| FaxNumber: | 8606454132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2010 | ||||||||
| LastUpdateDate: | 05/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY29408 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.