Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCSW #828 | WY |
NPI | 1003106725 |
---|---|
Provider Name | Laura Carol Long |
First Address | Lusk, WY 82225-0036 |
Second Address | Casper, WY 82601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 30/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106402907 | (05) | WY |