Provider Demographics
NPI:1932404266
Name:INGRID S. LONGO, PC
Entity Type:Organization
Organization Name:INGRID S. LONGO, PC
Other - Org Name:INGRID S LONGO MSW LICSW
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:SCHOLZ
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-365-7111
Mailing Address - Street 1:36 BACK ST
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:VT
Mailing Address - Zip Code:05345-9523
Mailing Address - Country:US
Mailing Address - Phone:802-365-7111
Mailing Address - Fax:802-365-7111
Practice Address - Street 1:36 BACK ST
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:VT
Practice Address - Zip Code:05345-9523
Practice Address - Country:US
Practice Address - Phone:802-365-7111
Practice Address - Fax:802-365-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT4771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN1736Medicaid
VTLOVN1736Medicare PIN