Provider Demographics
NPI:1023205945
Name:LUONGO, MICHAEL LOUIS (LPC, LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:LUONGO
Suffix:
Gender:M
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 WILLIMANTIC RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHAPLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06235-2532
Mailing Address - Country:US
Mailing Address - Phone:860-455-9812
Mailing Address - Fax:860-859-9492
Practice Address - Street 1:267 WILLIMANTIC RD
Practice Address - Street 2:SUITE #5
Practice Address - City:CHAPLIN
Practice Address - State:CT
Practice Address - Zip Code:06235-2505
Practice Address - Country:US
Practice Address - Phone:860-455-9812
Practice Address - Fax:860-859-9492
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTMCD008001794Medicaid