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General NPI Number Information
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NPI Number | 1265632558
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Entity Type | Individual
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Provider Name | CYNTHIA NICOLE LONGINO MFT
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Gender | Female
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 15305 RAYEN ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-5117
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Country | US
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Telephone | 323-223-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 15305 RAYEN ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-5117
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Country | US
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Telephone | 323-892-3423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 78627
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License Number State | CA
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