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General NPI Number Information
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NPI Number | 1285173823
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Entity Type | Organization
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Legal Business Name | DR SOPHIE LONGWILL, LLC
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 412 E KING ST
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City | MALVERN
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State | PA
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Zip | 19355-3004
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Country | US
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Telephone | 302-438-7325
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Fax |
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Provider Business Mailing Address
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Address Line | 412 E KING ST
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City | MALVERN
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State | PA
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Zip | 19355-3004
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Country | US
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Telephone | 302-438-7325
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SOPHIE ARIEL LONGWILL
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Credential | PSYD
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Telephone | 302-438-7325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017995
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License Number State | PA
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