Provider Demographics
NPI:1265591796
Name:MARQUEZ, LONGFELLOW (LIMHP-LDAC)
Entity type:Individual
Prefix:MR
First Name:LONGFELLOW
Middle Name:
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:LIMHP-LDAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10206 CASPIAN DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3234
Mailing Address - Country:US
Mailing Address - Phone:402-765-8854
Mailing Address - Fax:531-375-5374
Practice Address - Street 1:10206 CASPIAN DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3234
Practice Address - Country:US
Practice Address - Phone:402-765-8854
Practice Address - Fax:531-375-5374
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health