Provider Demographics
NPI:1932243557
Name:LONGWELL, LOIS (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:LONGWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WESTBROOK LN
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2330
Mailing Address - Country:US
Mailing Address - Phone:203-623-6817
Mailing Address - Fax:203-283-7857
Practice Address - Street 1:57 PLAINS RD STE 2C
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:203-623-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0012561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140001256CT06OtherANTHEM BEHAVIORAL HEALTH
CT004169737Medicaid
CT079329OtherMAGELLAN BEHAVIORAL HEALT
CTP381962OtherOXFORD HEALTH PLANS
CT800003805Medicare ID - Type Unspecified