Healthcare Provider Details

I. General information

NPI: 1063600435
Provider Name (Legal Business Name): DEBORAH LONG LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SAYRE AVE
PHILLIPSBURG NJ
08865-3326
US

IV. Provider business mailing address

319 MAPLE ST ATTN AVAZQUEZ
PERTH AMBOY NJ
08861-4101
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-2074
  • Fax:
Mailing address:
  • Phone: 732-324-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05263900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: