Healthcare Provider Details

I. General information

NPI: 1669272555
Provider Name (Legal Business Name): CRISTINA LONGETTI LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 EXCELSIOR AVE
STATEN ISLAND NY
10309-3554
US

IV. Provider business mailing address

104 EXCELSIOR AVE
STATEN ISLAND NY
10309-3554
US

V. Phone/Fax

Practice location:
  • Phone: 646-267-8408
  • Fax:
Mailing address:
  • Phone: 646-267-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: