Provider Demographics
NPI:1962546184
Name:LONGSWORTH, ELENA POWELL (MFT, RN, CNS)
Entity type:Individual
Prefix:MS
First Name:ELENA
Middle Name:POWELL
Last Name:LONGSWORTH
Suffix:
Gender:F
Credentials:MFT, RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3504
Mailing Address - Country:US
Mailing Address - Phone:831-662-0139
Mailing Address - Fax:831-662-0139
Practice Address - Street 1:517 CEDAR ST
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3504
Practice Address - Country:US
Practice Address - Phone:831-662-0139
Practice Address - Fax:831-662-0139
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist