Provider Demographics
NPI:1790920205
Name:LONGO, ANDREA (MS, CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:LONGO
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1244
Mailing Address - Country:US
Mailing Address - Phone:917-414-0855
Mailing Address - Fax:
Practice Address - Street 1:70 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1244
Practice Address - Country:US
Practice Address - Phone:917-414-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0176721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist