Provider Demographics
NPI:1720576903
Name:LONG, SCOTT A (LSW, BSW)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:LONG
Suffix:
Gender:M
Credentials:LSW, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 FAIRGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1966
Mailing Address - Country:US
Mailing Address - Phone:513-785-4895
Mailing Address - Fax:513-785-4896
Practice Address - Street 1:1900 FAIRGROVE AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-1966
Practice Address - Country:US
Practice Address - Phone:513-785-4895
Practice Address - Fax:513-785-4896
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1601257104100000X
OHS.2005095104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker