Provider Demographics
NPI:1619136033
Name:DELONG, VIRGINIA DECKER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DECKER
Last Name:DELONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 KINGS HWY E
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1205
Mailing Address - Country:US
Mailing Address - Phone:856-261-1357
Mailing Address - Fax:856-428-2340
Practice Address - Street 1:344 KINGS HWY E
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1205
Practice Address - Country:US
Practice Address - Phone:856-261-1357
Practice Address - Fax:856-428-2340
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05204100172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker