| Dr Sophie Longwill, Llc | |
|
412 E King St Malvern PA 19355-3004 | |
| (302) 438-7325 | |
| Not Available |
| Full Name | Dr Sophie Longwill, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 412 E King St, Malvern, Pennsylvania |
| Authorized Official Name and Position | Sophie Ariel Longwill (PSYCHOLOGIST) |
| Authorized Official Contact | 3024387325 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Sophie Longwill, Llc 412 E King St Malvern PA 19355-3004 Ph: (302) 438-7325 | Dr Sophie Longwill, Llc 412 E King St Malvern PA 19355-3004 Ph: (302) 438-7325 |
| NPI Number | 1285173823 |
|---|---|
| Provider Enumeration Date | 02/15/2017 |
| Last Update Date | 02/15/2017 |
| Medicare PECOS PAC ID | 6305122839 |
|---|---|
| Medicare Enrollment ID | O20170417000920 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285173823 | NPI | - | NPPES |
| 1679931810 | Other | PA | NPI 1 (INDIVIDUAL ) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PS017995 (Pennsylvania) | Primary |
| Provider Name | Sophie A Longwill |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679931810 PECOS PAC ID: 2365728896 Enrollment ID: I20170406002121 |
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