Provider Demographics
NPI:1104869973
Name:LONGO, JOHN M (LICSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:LONGO
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HAVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2123
Mailing Address - Country:US
Mailing Address - Phone:978-388-8054
Mailing Address - Fax:978-388-8033
Practice Address - Street 1:110 HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2123
Practice Address - Country:US
Practice Address - Phone:978-388-8054
Practice Address - Fax:978-388-8033
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11321041C0700X
MA238411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1132OtherLICSW
MAP03128OtherBLUE CROSS BLUE SHIELD
MA23841OtherLICSW