Provider Demographics
NPI:1669272555
Name:LONGETTI, CRISTINA (LCAT)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:LONGETTI
Suffix:
Gender:
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 EXCELSIOR AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3554
Mailing Address - Country:US
Mailing Address - Phone:646-267-8408
Mailing Address - Fax:
Practice Address - Street 1:104 EXCELSIOR AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3554
Practice Address - Country:US
Practice Address - Phone:646-267-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002956221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist