Provider Demographics
NPI:1437467586
Name:ELAINE A BLONG LCSW PA
Entity Type:Organization
Organization Name:ELAINE A BLONG LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLONG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:301-916-9374
Mailing Address - Street 1:13243 AUTUMN MIST CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2138
Mailing Address - Country:US
Mailing Address - Phone:301-916-9374
Mailing Address - Fax:301-916-1045
Practice Address - Street 1:13243 AUTUMN MIST CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2138
Practice Address - Country:US
Practice Address - Phone:301-916-9374
Practice Address - Fax:301-916-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty