Provider Demographics
NPI:1124877550
Name:LONGTOE, LAUREN (MHC-LIMITED PERMIT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LONGTOE
Suffix:
Gender:F
Credentials:MHC-LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 ESPERANCE RD
Mailing Address - Street 2:
Mailing Address - City:ESPERANCE
Mailing Address - State:NY
Mailing Address - Zip Code:12066-2009
Mailing Address - Country:US
Mailing Address - Phone:518-491-3161
Mailing Address - Fax:
Practice Address - Street 1:3761 CARMAN ROAD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303
Practice Address - Country:US
Practice Address - Phone:518-355-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP128164101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health