MEDICARE: MS. RUTHANN LONGO MA, LPC

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	101YM0800X	Mental Health Counselor	37PC00300800	NJ

General Provider Information

NPI Number	:	1528131125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTHANN LONGO MA, LPC

Provider Business Mailing Address
First Line	:	31 BRENTWOOD DR
Second Line	:
City	:	VERONA
State	:	NJ
Zip	:	07044-2518
Country	:	US
Telephone Number	:	973-432-9402
Fax Number	:

Provider Business Practice Location Address
First Line	:	543 VALLEY RD STE 11
Second Line	:
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1881
Country	:	US
Telephone Number	:	973-432-9402
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	11/09/2024

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