Provider Demographics
NPI:1326242033
Name:LONG, DANIELLE (ASW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EMELINE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1976
Mailing Address - Country:US
Mailing Address - Phone:831-454-4546
Mailing Address - Fax:831-454-4484
Practice Address - Street 1:1400 EMELINE AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1976
Practice Address - Country:US
Practice Address - Phone:831-454-4546
Practice Address - Fax:831-454-4484
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW12323101YM0800X, 104100000X
CA847631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC 70042FOtherSANTA CRUZ COUNTY CA MEDI-CAL SITE PROVIDER NUMBERS
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE SITE PROVIDER NUMBERS
CAZZZ92069ZOtherSANTA CRUZ COUNTY MEDICARE SITE PROVIDER NUMBERS
CAFHC 70044FOtherSANTA CRUZ COUNTY CA MEDI-CAL SITE PROVIDER NUMBERS
CAZZZ91891ZOtherSANTA CRUZ COUNTY MEDICARE SITE PROVIDER NUMBERS