Healthcare Provider Details

I. General information

NPI: 1629898622
Provider Name (Legal Business Name): ROBIN GUILES LONGNIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E 44TH AVE
EUGENE OR
97405-4580
US

IV. Provider business mailing address

950 E 44TH AVE
EUGENE OR
97405-4580
US

V. Phone/Fax

Practice location:
  • Phone: 541-968-0363
  • Fax:
Mailing address:
  • Phone: 541-968-0363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7104
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: