Provider Demographics
NPI:1720590110
Name:LONGMORE, GREGORY (LMHC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:LONGMORE
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 E 56TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4001
Mailing Address - Country:US
Mailing Address - Phone:929-465-6383
Mailing Address - Fax:718-676-0695
Practice Address - Street 1:1567 E 56TH ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4001
Practice Address - Country:US
Practice Address - Phone:929-465-6383
Practice Address - Fax:718-676-0695
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health