Healthcare Provider Details

I. General information

NPI: 1740055086
Provider Name (Legal Business Name): SEASON LONGORIA LLBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 COBB ST
CADILLAC MI
49601-2540
US

IV. Provider business mailing address

401 HUSTON ST
CADILLAC MI
49601-1669
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-3463
  • Fax:
Mailing address:
  • Phone: 231-884-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6852093873
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: