Provider Demographics
NPI:1568498798
Name:LONGHI, GABRIEL R (PSY D)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:R
Last Name:LONGHI
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 AMERICAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-1498
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019642103TC0700X
NY014710103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ638207Medicaid
NM23022825Medicaid
P47056Medicare UPIN
TX8HZ05QMedicare ID - Type UnspecifiedHSZ003
AZ638207Medicaid
TX8HZ12LMedicare ID - Type UnspecifiedHSZ006
TX8HZ44TMedicare ID - Type UnspecifiedHSZ001
NM23022825Medicaid