Provider Demographics
NPI:1437527108
Name:LONGINI, RACHEL ALIZA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALIZA
Last Name:LONGINI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LONGINI
Other - Middle Name:RACHEL
Other - Last Name:ALIZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:743 EMPIRE BLVD APT A1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5353
Mailing Address - Country:US
Mailing Address - Phone:917-773-8439
Mailing Address - Fax:
Practice Address - Street 1:743 EMPIRE BLVD APT A1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5353
Practice Address - Country:US
Practice Address - Phone:917-773-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022699103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical