Provider Demographics
NPI:1366929242
Name:MASSEY-LONGO, LEAH MICHELE
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELE
Last Name:MASSEY-LONGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:M
Other - Last Name:LONGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1040 W MACARTHUR BLVD APT 20
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-4604
Mailing Address - Country:US
Mailing Address - Phone:727-432-0386
Mailing Address - Fax:
Practice Address - Street 1:301 THE CITY DR S
Practice Address - Street 2:MANCHESTER OFFICE BUILDING
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92848
Practice Address - Country:US
Practice Address - Phone:714-935-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health