Provider Information for 1902813819
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Mrs. LISA MARIE LONGO MaEd/WSC
Sex: Female
NPI: 1902813819
Last Updated: 2007-07-09
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1902813819 | ||||||||
| Enumeration Date | 2006-08-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 814 DESOTO AVE LEHIGH ACRES, FL 33936-8113 United States Phone: 239-303-2900 | Fax:239-303-2909 | ||||||||
| Primary Practice Address | 814 DESOTO AVE LEHIGH ACRES, FL 33936-8113 United States Phone: 239-303-2900 | Fax:239-303-2909 | ||||||||
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