Provider Demographics
NPI:1902956410
Name:LONGO, LESLIE A (PHD, PCC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:LONGO
Suffix:
Gender:F
Credentials:PHD, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 GAYLORD AVE
Mailing Address - Street 2:
Mailing Address - City:MASURY
Mailing Address - State:OH
Mailing Address - Zip Code:44438-9728
Mailing Address - Country:US
Mailing Address - Phone:330-448-1631
Mailing Address - Fax:
Practice Address - Street 1:2201 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2727
Practice Address - Country:US
Practice Address - Phone:724-981-7141
Practice Address - Fax:724-981-7148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH834979000OtherMAGELLAN INSURANCE
OH000000386571OtherANTHEM INSURANCE