Provider Demographics
NPI:1285173823
Name:DR SOPHIE LONGWILL, LLC
Entity type:Organization
Organization Name:DR SOPHIE LONGWILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOPHIE
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:LONGWILL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:302-438-7325
Mailing Address - Street 1:412 E KING ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3004
Mailing Address - Country:US
Mailing Address - Phone:302-438-7325
Mailing Address - Fax:
Practice Address - Street 1:412 E KING ST
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3004
Practice Address - Country:US
Practice Address - Phone:302-438-7325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1679931810OtherNPI 1 (INDIVIDUAL )