Provider Demographics
NPI:1710423306
Name:LONGO, RONALD (LCSW)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:LONGO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:RON
Other - Middle Name:
Other - Last Name:LONGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:571-291-6131
Mailing Address - Fax:571-291-6135
Practice Address - Street 1:21170 ASHBY PONDS BLVD
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:571-291-6131
Practice Address - Fax:571-291-6135
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040087161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical