Provider Demographics
NPI:1083811582
Name:LONG, PATRICIA L (LCSW-R)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1218
Mailing Address - Country:US
Mailing Address - Phone:585-330-6701
Mailing Address - Fax:585-658-9331
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1218
Practice Address - Country:US
Practice Address - Phone:585-330-6701
Practice Address - Fax:585-658-9331
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057507-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical