Individual
DIANE M LONGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
620 21ST ST, ST AUGUSTINE, FL 32084-1706
(904) 825-8091
(904) 824-7895
Mailing address
620 21ST ST, ST AUGUSTINE, FL 32084-1706
(904) 825-8091
(904) 824-7895
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW10907
FL
Other
Enumeration date
09/24/2012
Last updated
09/24/2012
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