Provider Demographics
NPI:1679931810
Name:LONGWILL, SOPHIE A
Entity Type:Individual
Prefix:DR
First Name:SOPHIE
Middle Name:A
Last Name:LONGWILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:A
Other - Last Name:HADIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 E KING ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3004
Mailing Address - Country:US
Mailing Address - Phone:302-438-7325
Mailing Address - Fax:610-251-5210
Practice Address - Street 1:412 E KING ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3004
Practice Address - Country:US
Practice Address - Phone:302-438-7325
Practice Address - Fax:610-251-5210
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist