Individual provider Active NPI

Michael W Long, LMSW

  • Social Worker
  • Hattiesburg, MS
National Provider Identifier
1184896128
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
M7416 Issued in MS
Practice address
103 S 19TH Ave
Hattiesburg, MS 39401-6171
Phone
(601) 544-4641
Fax
(601) 584-4053
NPI assigned
Mar 31, 2008
Last updated
Mar 31, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X M7416 MS Primary

Addresses

Primary practice location

103 S 19TH Ave
Hattiesburg, MS 39401-6171

Mailing address

103 S 19TH Ave
Hattiesburg, MS 39401-6171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
M7416MSMDSocial Worker

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1184896128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S 19TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394016171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S 19TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394016171",
            "telephone_number": "601-544-4641",
            "fax_number": "601-584-4053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "MICHAEL",
        "middle_name": "W",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-31",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MS",
            "license": "M7416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.