Healthcare Provider Details

I. General information

NPI: 1336476340
Provider Name (Legal Business Name): KAY M LONG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 CHURCH ST STE 300
NEW HAVEN CT
06510-1800
US

IV. Provider business mailing address

234 CHURCH ST STE 300
NEW HAVEN CT
06510-1800
US

V. Phone/Fax

Practice location:
  • Phone: 203-498-9091
  • Fax:
Mailing address:
  • Phone: 203-498-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberCT001475
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: