Healthcare Provider Details

I. General information

NPI: 1992140602
Provider Name (Legal Business Name): RICHELLE LONG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 12/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 POWER INN RD STE 140
SACRAMENTO CA
95826-3889
US

IV. Provider business mailing address

3331 POWER INN RD STE 140
SACRAMENTO CA
95826-3889
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-1183
  • Fax: 916-875-6904
Mailing address:
  • Phone: 916-875-1183
  • Fax: 916-875-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY27361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: