Provider Demographics
NPI:1457478455
Name:LONG, PATRICIA F (CSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:F
Last Name:LONG
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 W CEDAR LN
Mailing Address - Street 2:SUITE 209 A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1516
Mailing Address - Country:US
Mailing Address - Phone:301-502-7289
Mailing Address - Fax:301-581-0595
Practice Address - Street 1:5411 W CEDAR LN
Practice Address - Street 2:SUITE 209 A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1516
Practice Address - Country:US
Practice Address - Phone:301-502-7289
Practice Address - Fax:301-581-0595
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD078821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD490797Medicare PIN