MEDICARE: SCOTT ANTHONY LONG LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	090402	IA

General Provider Information

NPI Number	:	1033696034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ANTHONY LONG LISW

Provider Business Mailing Address
First Line	:	6667 E 35TH RD
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-8209
Country	:	US
Telephone Number	:	928-271-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 E 16TH ST STE 103
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85365-2128
Country	:	US
Telephone Number	:	928-271-8700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	05/29/2026

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Directions to “ SCOTT ANTHONY LONG LISW” Practice Location

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