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General NPI Number Information
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NPI Number | 1487976643
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Entity Type | Individual
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Provider Name | SUSANNE LEA LONGWELL LCSW, PPSC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2010
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Last Update Date | 10/29/2018
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Provider Practice Location Address
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Address Line | 4383 CHEROKEE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92104-1526
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Country | US
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Telephone | 619-258-6877
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Fax |
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Provider Business Mailing Address
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Address Line | 4383 CHEROKEE AVE
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City | SAN DIEGO
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State | CA
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Zip | 92104-1526
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Country | US
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Telephone | 619-573-8519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 65304
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License Number State | CA
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