MEDICARE: MRS. DAENA LYNN LONGENECKER LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MF000895	PA

General Provider Information

NPI Number	:	1396213641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAENA LYNN LONGENECKER LMFT

Provider Business Mailing Address
First Line	:	83 EAST MAIN STREET
Second Line	:	PO BOX 357
City	:	MT. JOY
State	:	PA
Zip	:	17552
Country	:	US
Telephone Number	:	717-413-9594
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 E MAIN ST
Second Line	:
City	:	MOUNT JOY
State	:	PA
Zip	:	17552-1424
Country	:	US
Telephone Number	:	717-413-9594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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