MEDICARE: PATRICIA DIANE LONG-BROHM MSW, LICSW

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
1	1041C0700X	Clinical Social Worker	20819	MN
2	1041C0700X	Clinical Social Worker	LW60503508	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32655011	OTHER	KS	BCBS OF KC

General Provider Information

NPI Number	:	1770527616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DIANE LONG-BROHM MSW, LICSW

Provider Business Mailing Address
First Line	:	6523 CALIFORNIA AVE SW # B177
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-1833
Country	:	US
Telephone Number	:	785-865-9645
Fax Number	:

Provider Business Practice Location Address
First Line	:	4215 SW SULLIVAN ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98136-2365
Country	:	US
Telephone Number	:	785-865-9645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/23/2021

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