Provider Demographics
NPI:1851489173
Name:LONIGRO, SEBASTIAN S (LICENSED PSYCHOLOGIS)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:S
Last Name:LONIGRO
Suffix:
Gender:M
Credentials:LICENSED PSYCHOLOGIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PAUL DR
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-3610
Mailing Address - Country:US
Mailing Address - Phone:724-542-7550
Mailing Address - Fax:
Practice Address - Street 1:58 W MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3303
Practice Address - Country:US
Practice Address - Phone:724-430-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000524L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA328826OtherSTATE CERTIFICATION NUMBE
PA331025254OtherTAX ID NUMBER NORTH
PA328826OtherSTATE CERTIFICATION NUMBE