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General NPI Number Information
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NPI Number | 1689298044
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Entity Type | Individual
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Provider Name | MICHELLE RENEE PERLONGO LMHC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 12 JEFFERSON BLVD STE 2
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City | STATEN ISLAND
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State | NY
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Zip | 10312-3330
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Country | US
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Telephone | 718-966-0317
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Fax | 917-791-8248
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Provider Business Mailing Address
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Address Line | 796 TYSENS LN
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City | STATEN ISLAND
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State | NY
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Zip | 10306-5620
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Country | US
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Telephone | 646-872-4354
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Fax | 917-791-8248
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 010110
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License Number State | NY
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