Doctor Name: | THOMAS LONG |
NPI Number: | 1073826343 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSW |
License Number: | 104641 |
Business Practice Address: | 540 Vfw Pkwy West Roxbury, MA - 021321332 |
Business Phone Number: | 6173252993 |
Business Fax Number: | |
Mailing Address: | 540 Vfw Pkwy, WEST ROXBURY |
State: | MA |
Postal Code: | 021321332 |
Phone Number: | 6173252993 |
Fax Number: | |
NPI Enumeration Date: | 07/15/2010 |
NPI Last Update Date: | 07/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 104641 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |