Individual
JACQUELINE LONGMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3720 74TH ST FL 3, JACKSON HEIGHTS, NY 11372-6338
(718) 426-6222
(718) 426-6222
Mailing address
3720 74TH ST FL 3, JACKSON HEIGHTS, NY 11372-6338
(718) 426-6222
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
2-21933
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
21933
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000000
—
NY
Enumeration date
11/29/2017
Last updated
11/29/2017
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