Healthcare Provider Details

I. General information

NPI: 1588577951
Provider Name (Legal Business Name): AMANDA LONGO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1140
US

IV. Provider business mailing address

2005 PALMER AVE
LARCHMONT NY
10538-2437
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: