1295514255 NPI number — MIRIAM N/A LONGORIA BSW

Table of content: MIRIAM N/A LONGORIA BSW (NPI 1295514255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295514255 NPI number — MIRIAM N/A LONGORIA BSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONGORIA
Provider First Name:
MIRIAM
Provider Middle Name:
N/A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONGORIA
Provider Other First Name:
MIRIAM
Provider Other Middle Name:
N/A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295514255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1739 W CARTMELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASCO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99301-4032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-361-4040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LUTHERAN COMMUNITY SERVICES NW
Provider Second Line Business Practice Location Address:
3321 W KENNEWICK AVE SUITE 150
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-6446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)