Individual
KELLY LONGACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSED, CAS, NCSP
Contact information
Practice address
1 RAPP RD, ALBANY, NY 12203-4491
(518) 867-3061
Mailing address
1 RAPP RD, ALBANY, NY 12203-4491
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
508536112
NY
Other
Enumeration date
06/06/2012
Last updated
06/06/2012
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