Provider Demographics
NPI:1437780509
Name:LONGMORE, ALICIA M (LISW)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:LONGMORE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 MONROE ST STE A1
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2208
Mailing Address - Country:US
Mailing Address - Phone:419-517-7073
Mailing Address - Fax:419-517-0122
Practice Address - Street 1:5800 MONROE ST STE A1
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2208
Practice Address - Country:US
Practice Address - Phone:419-517-7073
Practice Address - Fax:419-517-0122
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18013771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical