Provider Demographics
NPI:1700552973
Name:LONGCHAMPS, OLIVIA MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:LONGCHAMPS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 COUNTRY FAIR CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2807
Mailing Address - Country:US
Mailing Address - Phone:815-931-3132
Mailing Address - Fax:
Practice Address - Street 1:6212 COUNTRY FAIR CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2807
Practice Address - Country:US
Practice Address - Phone:815-931-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty