Mark Jacob Longsjo, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1026908 Issued in MA

Practice address

McLean Hospital Southeast Location
940 Belmont Street
Brockton, MA 02301

Phone

(508) 894-8320

Fax

(508) 894-8334

NPI assigned

Jul 6, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: longsjo.mark.mcl@direct.partners.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The McLean Hospital Corporation

  • Psychiatry Physician
  • Belmont, MA
  • NPI 1114979580

  Clinical

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013949809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 MILL ST",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024781041",
            "telephone_number": "508-894-8320",
            "fax_number": "508-894-8334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MCLEAN HOSPITAL SOUTHEAST LOCATION",
            "address_2": "940 BELMONT STREET",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "508-894-8320",
            "fax_number": "508-894-8334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONGSJO",
        "first_name": "MARK",
        "middle_name": "JACOB",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "1026908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dominga Logan
• Linda Susan Logan, RN
• Roberta Helen Logan, RN
• Shashanka Lokireddy
• Corinne Dorothy Lolar, R.N
• Margaret Ann Longwe, PT
• Allison Lonstein, MD
• Kelvin Lopes Correia
• Alison Lopes, LCSW
• Andrea Lopes

• Clinical Social Worker in Brockton, MA
• Providers in Brockton, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.