Provider Demographics
NPI:1538422852
Name:LUONGO, ANN M (LPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:LUONGO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 YANTIC LN
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-1454
Mailing Address - Country:US
Mailing Address - Phone:860-887-2695
Mailing Address - Fax:
Practice Address - Street 1:151 BROAD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3327
Practice Address - Country:US
Practice Address - Phone:860-342-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional