MEDICARE: MRS. STEPHANIE MARIE LONGO BCBA, LMSW, ITDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist		FL
2	103K00000X	Behavior Analyst	1-20-45233	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417101585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE MARIE LONGO BCBA, LMSW, ITDS

Provider Business Mailing Address
First Line	:	542 AMHERST ST
Second Line	:
City	:	NASHUA
State	:	NH
Zip	:	03063-1016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 W PALMETTO PARK RD STE 200
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3430
Country	:	US
Telephone Number	:	917-204-5852
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2008
Last Update Date	:	03/27/2025

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