Provider Demographics
NPI:1447316476
Name:LONGO-LOCKSPEISER, LINDA PATRICIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:PATRICIA
Last Name:LONGO-LOCKSPEISER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:P
Other - Last Name:LOCKSPEISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:186 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5035
Mailing Address - Country:US
Mailing Address - Phone:516-285-5227
Mailing Address - Fax:516-872-9304
Practice Address - Street 1:15 FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-4000
Practice Address - Country:US
Practice Address - Phone:516-872-9304
Practice Address - Fax:516-872-9304
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4501Medicare ID - Type Unspecified