Provider Demographics
NPI:1710493234
Name:LONGSTREATH, MEREDITH REBECCA (MS, LSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:REBECCA
Last Name:LONGSTREATH
Suffix:
Gender:F
Credentials:MS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-1105
Mailing Address - Country:US
Mailing Address - Phone:573-337-8006
Mailing Address - Fax:
Practice Address - Street 1:474 N YELLOW SPRINGS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2463
Practice Address - Country:US
Practice Address - Phone:937-390-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701656104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker