Provider Demographics
NPI:1720639339
Name:LONGER, RACHEL ALEXANDRA (MSS, LCSW, CET II)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ALEXANDRA
Last Name:LONGER
Suffix:
Gender:F
Credentials:MSS, LCSW, CET II
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ALEXANDRA
Other - Last Name:LONGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSS, LSW, CET I
Mailing Address - Street 1:444 W BALTIMORE AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3853
Mailing Address - Country:US
Mailing Address - Phone:609-284-9702
Mailing Address - Fax:
Practice Address - Street 1:1167 W BALTIMORE PIKE # 132
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5127
Practice Address - Country:US
Practice Address - Phone:609-284-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136291104100000X
PACW0222981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty