Provider Demographics
NPI:1255487088
Name:LONGANO, DEBORAH M (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:LONGANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:M
Other - Last Name:LONGANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2400 AUGUSTA DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:713-952-4842
Mailing Address - Fax:713-667-0359
Practice Address - Street 1:2400 AUGUSTA DR
Practice Address - Street 2:SUITE 312
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057
Practice Address - Country:US
Practice Address - Phone:713-952-4842
Practice Address - Fax:713-667-0359
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24522103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOU83POtherBCBS