Organization Name: | DR. JACK M. LONG & ASSOC., P.A. |
NPI Number: | 1144599572 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACK MARTIN LONG (PSYCHOTHERAPIST) |
Mailing Address: | 720 Maiden Choice Ln Suite C Catonsville |
State: | MD US |
Postal Code: | 212285940 |
Phone Number: | 4107445499 |
Fax Number: | 4104550894 |
NPI Enumeration Date: | 12/13/2011 |
NPI Last Update Date: | 12/13/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 03068 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |