MEDICARE: MRS. LISA MARIE LONGO MAED/WSC

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	101Y00000X	Counselor

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

General Provider Information

NPI Number	:	1902813819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA MARIE LONGO MAED/WSC

Provider Business Mailing Address
First Line	:	814 DESOTO AVE
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-8113
Country	:	US
Telephone Number	:	239-303-2900
Fax Number	:	239-303-2909

Provider Business Practice Location Address
First Line	:	814 DESOTO AVE
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-8113
Country	:	US
Telephone Number	:	239-303-2900
Fax Number	:	239-303-2909

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	04/08/2026

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