Healthcare Provider Details

I. General information

NPI: 1538422852
Provider Name (Legal Business Name): ANN M LUONGO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 BROAD ST
MIDDLETOWN CT
06457-3327
US

IV. Provider business mailing address

168 YANTIC LN
NORWICH CT
06360-1454
US

V. Phone/Fax

Practice location:
  • Phone: 860-342-0760
  • Fax:
Mailing address:
  • Phone: 860-887-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001217
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: