Provider Demographics
NPI:1962666487
Name:LONGO, RONALD PATRICK (PSYD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PATRICK
Last Name:LONGO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 S OCEAN DR
Mailing Address - Street 2:APARTMENT 205W
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-6643
Mailing Address - Country:US
Mailing Address - Phone:954-612-2147
Mailing Address - Fax:
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:B-8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-598-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical