MEDICARE: KIRSTEN LONG LCSW

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	1041C0700X	Clinical Social Worker	16989	LA

General Provider Information

NPI Number	:	1588505093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN LONG LCSW

Provider Business Mailing Address
First Line	:	105 TUDOR ST
Second Line	:
City	:	PINEVILLE
State	:	LA
Zip	:	71360-5117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 HIGHWAY 28 E
Second Line	:
City	:	PINEVILLE
State	:	LA
Zip	:	71360-4650
Country	:	US
Telephone Number	:	318-664-3428
Fax Number	:

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

Provider Enumeration Date	:	04/01/2026
Last Update Date	:	04/01/2026

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Directions to “ KIRSTEN LONG LCSW” Practice Location

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