Provider Demographics
NPI:1386707768
Name:LONSKI, MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LONSKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-2214
Mailing Address - Country:US
Mailing Address - Phone:203-912-5547
Mailing Address - Fax:
Practice Address - Street 1:3 NEW YORK PLZ
Practice Address - Street 2:SUITE 1401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2442
Practice Address - Country:US
Practice Address - Phone:203-912-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001665103T00000X
NY007029103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist