Provider Demographics
NPI:1144795477
Name:LONG, MADILYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MADILYN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 SE 33RD PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3446
Mailing Address - Country:US
Mailing Address - Phone:971-264-0944
Mailing Address - Fax:503-594-2308
Practice Address - Street 1:4233 SE 33RD PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3446
Practice Address - Country:US
Practice Address - Phone:971-264-0944
Practice Address - Fax:503-594-2308
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-13
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical