Provider Demographics
NPI:1013434505
Name:SUMNER-LONGBOY, TALIESIN (MSW)
Entity type:Individual
Prefix:
First Name:TALIESIN
Middle Name:
Last Name:SUMNER-LONGBOY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TALIESIN
Other - Middle Name:
Other - Last Name:SUMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 81766
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-0284
Mailing Address - Country:US
Mailing Address - Phone:808-481-7283
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 81766
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-0284
Practice Address - Country:US
Practice Address - Phone:808-481-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker