Provider Demographics
NPI:1801311287
Name:LONGOBARDI, MICHAEL (LMHC, CASAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LONGOBARDI
Suffix:
Gender:M
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 MINEOLA AVE STE 2I
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2022
Mailing Address - Country:US
Mailing Address - Phone:516-317-8457
Mailing Address - Fax:
Practice Address - Street 1:142 MINEOLA AVE STE 2I
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2022
Practice Address - Country:US
Practice Address - Phone:516-317-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28195101YA0400X
NY010052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)