Provider Demographics
NPI:1629300066
Name:LONG-RISLIN, JAMEY LEEANNE (MSW, LSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMEY
Middle Name:LEEANNE
Last Name:LONG-RISLIN
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:MRS
Other - First Name:JAMEY
Other - Middle Name:LEEANNE
Other - Last Name:RISLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSW
Mailing Address - Street 1:308 OWEN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 OWEN AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-1032
Practice Address - Country:US
Practice Address - Phone:973-930-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125939101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker