Provider Demographics
NPI:1639545437
Name:KIRANJIT K. LONGAKER, MENTAL HEALTH COUNSELOR, PLLC
Entity Type:Organization
Organization Name:KIRANJIT K. LONGAKER, MENTAL HEALTH COUNSELOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRANJIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:LONGAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:607-592-6539
Mailing Address - Street 1:112 TREVA AVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6138
Mailing Address - Country:US
Mailing Address - Phone:607-592-6539
Mailing Address - Fax:
Practice Address - Street 1:401 E STATE ST STE 400
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4400
Practice Address - Country:US
Practice Address - Phone:607-592-6539
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-15
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006416261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)