| Doctor Name: | PATRICIA JOANN LONG |
| NPI Number: | 1114165412 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCMHC |
| License Number: | 068 0000382 |
| Business Practice Address: | 257 Main Street Hyde Park, VT - 05655 |
| Business Phone Number: | 8027937687 |
| Business Fax Number: | |
| Mailing Address: | Po Box 54, HYDE PARK |
| State: | VT |
| Postal Code: | 056550054 |
| Phone Number: | 8027937687 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2009 |
| NPI Last Update Date: | 01/26/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 068 0000382 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |