Basic Information
| Provider Information | |||||||||
| NPI: | 1538245766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANGENAUER | ||||||||
| FirstName: | BERNARD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 TOWER AVENUE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607142750 | ||||||||
| FaxNumber: | 8607148591 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 TOWER AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061121260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607142750 | ||||||||
| FaxNumber: | 8607148591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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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 | 2084P0804X | 12454 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 001124544 | 05 | CT | MEDICAID |