Provider Demographics
NPI:1013218577
Name:LUONGO, TERESA MARIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIA
Last Name:LUONGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SEQUOIA TRL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2144
Mailing Address - Country:US
Mailing Address - Phone:917-647-8516
Mailing Address - Fax:
Practice Address - Street 1:8 SEQUOIA TRL
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-2144
Practice Address - Country:US
Practice Address - Phone:917-647-8516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070934-1104100000X
NJ44SL05551900104100000X
NY230050611041S0200X
NY078328-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool