MEDICARE: MARY ELLEN LONERGAN 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	001647	CT

General Provider Information

NPI Number	:	1952647679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN LONERGAN LMFT

Provider Business Mailing Address
First Line	:	682 PROSPECT AVE STE 301
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-4238
Country	:	US
Telephone Number	:	860-502-8435
Fax Number	:

Provider Business Practice Location Address
First Line	:	682 PROSPECT AVE STE 301
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06105-4238
Country	:	US
Telephone Number	:	860-502-8435
Fax Number	:

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

Provider Enumeration Date	:	12/28/2012
Last Update Date	:	03/04/2026

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