Provider Demographics
NPI:1295831949
Name:LUONGO, FRANK (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:LUONGO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAWSON RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-1915
Mailing Address - Country:US
Mailing Address - Phone:207-400-7870
Mailing Address - Fax:
Practice Address - Street 1:18 LAWSON RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-1915
Practice Address - Country:US
Practice Address - Phone:207-400-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003412OtherBLUE CROSS/BLUE SHIELD
ME221930099Medicaid