Provider Demographics
NPI:1639313109
Name:LONGENECKER, HAROLD (PHD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:LONGENECKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6404
Mailing Address - Country:US
Mailing Address - Phone:207-782-2726
Mailing Address - Fax:207-333-3501
Practice Address - Street 1:415 RODMAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3942
Practice Address - Country:US
Practice Address - Phone:207-376-3022
Practice Address - Fax:207-333-3501
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1124103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431875799Medicaid