Provider Demographics
NPI:1194501437
Name:LONGSWORTH, DENESE ORQUIDEA (LSW)
Entity type:Individual
Prefix:MRS
First Name:DENESE
Middle Name:ORQUIDEA
Last Name:LONGSWORTH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:DENESE
Other - Middle Name:ORQUIDEA
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:7 SWAINE PL FL 2
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5215
Mailing Address - Country:US
Mailing Address - Phone:973-460-9172
Mailing Address - Fax:
Practice Address - Street 1:15 WARREN ST STE 23
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5436
Practice Address - Country:US
Practice Address - Phone:201-205-1131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06841400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker