Individual
MR. TIMOTHY RICHARD LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
160 DRAPER AVE, C/O CHILD INC., WARWICK, RI 02889-5047
(401) 732-5200
Mailing address
160 DRAPER AVE, C/O CHILD INC., WARWICK, RI 02889-5047
(401) 732-5200
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
1024584
MA
1041C0700X
Clinical Social Worker
Primary
ISW01394
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29583
BLUE CROSS COMMERCIAL
RI
01
—
412638
BLUE CROSS BLUE CHIP
RI
05
—
TL43466
—
RI
Enumeration date
05/17/2006
Last updated
11/09/2007
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