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NPI Code Detail

MEDICARE: KAITLYN ELIZABETH LONG LSW

MEDICARE: KAITLYN ELIZABETH LONG LSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker44SL06532700NJ

General Provider Information

NPI Number : 1295479616
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN ELIZABETH LONG LSW
Provider Business Mailing Address
First Line : 1127 ROUTE 47 S STE 9
Second Line :
City : RIO GRANDE
State : NJ
Zip : 08242-1609
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1127 ROUTE 47 S STE 9
Second Line :
City : RIO GRANDE
State : NJ
Zip : 08242-1609
Country : US
Telephone Number : 609-486-2003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2022
Last Update Date : 04/21/2022

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Directions to “ KAITLYN ELIZABETH LONG LSW” Practice Location

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