Provider Demographics
NPI:1720321482
Name:MICHAEL LUONGO, LPC, LLC
Entity Type:Organization
Organization Name:MICHAEL LUONGO, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:LUONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:860-455-9812
Mailing Address - Street 1:267 WILLIMANTIC RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAPLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06235-2532
Mailing Address - Country:US
Mailing Address - Phone:860-455-9812
Mailing Address - Fax:860-859-9492
Practice Address - Street 1:267 WILLIMANTIC RD STE 3
Practice Address - Street 2:
Practice Address - City:CHAPLIN
Practice Address - State:CT
Practice Address - Zip Code:06235-2532
Practice Address - Country:US
Practice Address - Phone:860-455-9812
Practice Address - Fax:860-859-9492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001182101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008001794Medicaid