Healthcare Provider Details

I. General information

NPI: 1528131125
Provider Name (Legal Business Name): RUTHANN LONGO MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 VALLEY RD STE 11
UPPER MONTCLAIR NJ
07043-1881
US

IV. Provider business mailing address

31 BRENTWOOD DR
VERONA NJ
07044-2518
US

V. Phone/Fax

Practice location:
  • Phone: 973-432-9402
  • Fax:
Mailing address:
  • Phone: 973-432-9402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00300800
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: