MEDICARE: CHRYSTINE MARIE LONGLEY LCSW. LMSW, LICSW

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	LICSW1121089	MA
2	104100000X	Social Worker	3396	CT
3	104100000X	Social Worker	221902	MA

General Provider Information

NPI Number	:	1710622089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRYSTINE MARIE LONGLEY LCSW. LMSW, LICSW

Provider Business Mailing Address
First Line	:	88 OLD GOSHEN RD
Second Line	:
City	:	WILLIAMSBURG
State	:	MA
Zip	:	01096-9707
Country	:	US
Telephone Number	:	860-214-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 OLD GOSHEN RD
Second Line	:
City	:	WILLIAMSBURG
State	:	MA
Zip	:	01096-9707
Country	:	US
Telephone Number	:	860-214-1090
Fax Number	:

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

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	01/07/2026

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