Provider Demographics
NPI:1437226701
Name:LONGO, RICHARD T (EDD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:LONGO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BROADLEAF CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028
Mailing Address - Country:US
Mailing Address - Phone:413-519-1960
Mailing Address - Fax:413-224-1592
Practice Address - Street 1:167 DWIGHT ROAD
Practice Address - Street 2:SUITE #104
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106
Practice Address - Country:US
Practice Address - Phone:413-519-1960
Practice Address - Fax:413-224-1592
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6395103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TF0200X, 103TM1800X, 320900000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities