Healthcare Provider Details

I. General information

NPI: 1386725026
Provider Name (Legal Business Name): WILLIAM LONGO MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 ASYLUM AVE
HARTFORD CT
06105-1901
US

IV. Provider business mailing address

896 ASYLUM AVE
HARTFORD CT
06105-1901
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-8241
  • Fax: 860-524-8143
Mailing address:
  • Phone: 860-522-8241
  • Fax: 860-524-8143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001765
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: