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General NPI Number Information
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NPI Number | 1639545437
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Entity Type | Organization
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Legal Business Name | KIRANJIT K. LONGAKER, MENTAL HEALTH COUNSELOR, PLLC
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Dates
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Enumeration Date | 08/15/2015
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 401 E STATE ST STE 400
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City | ITHACA
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State | NY
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Zip | 14850-4400
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Country | US
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Telephone | 607-592-6539
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Fax |
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Provider Business Mailing Address
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Address Line | 112 TREVA AVE
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City | ITHACA
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State | NY
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Zip | 14850-6138
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Country | US
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Telephone | 607-592-6539
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIRANJIT K LONGAKER
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Credential | LMHC
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Telephone | 607-592-6539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 006416
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License Number State | NY
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