Provider Demographics
NPI:1316224926
Name:LONG, WILLIAM HENRY (LSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:LONG
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ATLANTIC AVE
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-7022
Mailing Address - Country:US
Mailing Address - Phone:609-572-8800
Mailing Address - Fax:
Practice Address - Street 1:1401 ATLANTIC AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7022
Practice Address - Country:US
Practice Address - Phone:609-572-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05730700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker