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General NPI Number Information
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NPI Number | 1902813819
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Entity Type | Individual
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Provider Name | LISA MARIE LONGO MAED/WSC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 814 DESOTO AVE
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-8113
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Country | US
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Telephone | 239-303-2900
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Fax | 239-303-2909
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Provider Business Mailing Address
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Address Line | 814 DESOTO AVE
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-8113
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Country | US
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Telephone | 239-303-2900
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Fax | 239-303-2909
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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