Provider Demographics
NPI:1972599629
Name:BLONG, ELAINE A (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:A
Last Name:BLONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:A
Other - Last Name:BLONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW PA
Mailing Address - Street 1:13243 AUTUMN MIST CIR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2138
Mailing Address - Country:US
Mailing Address - Phone:301-916-9374
Mailing Address - Fax:301-916-1045
Practice Address - Street 1:13243 AUTUMN MIST CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2138
Practice Address - Country:US
Practice Address - Phone:301-916-9374
Practice Address - Fax:301-916-1045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD035081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00801Medicare ID - Type UnspecifiedGRP #
MD00B038E01Medicare PIN