Provider Demographics
NPI:1497797328
Name:LONGPRE, RONALD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:LONGPRE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MERRIMAC ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2357
Mailing Address - Country:US
Mailing Address - Phone:978-462-8160
Mailing Address - Fax:978-358-0037
Practice Address - Street 1:150 MERRIMAC ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2357
Practice Address - Country:US
Practice Address - Phone:978-462-8160
Practice Address - Fax:978-358-0037
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3405103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03439Medicare ID - Type Unspecified