Provider Demographics
NPI:1750832762
Name:LONGO, JENNI REBECCA (MSW, LISW, LCDCIII)
Entity Type:Individual
Prefix:MRS
First Name:JENNI
Middle Name:REBECCA
Last Name:LONGO
Suffix:
Gender:F
Credentials:MSW, LISW, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 N SANDUSKY ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1763
Mailing Address - Country:US
Mailing Address - Phone:614-259-8737
Mailing Address - Fax:
Practice Address - Street 1:163 N SANDUSKY ST STE 205
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1763
Practice Address - Country:US
Practice Address - Phone:614-259-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001203101YA0400X
OHS278111041C0700X
OHI.20020891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0282079Medicaid