Healthcare Provider Details

I. General information

NPI: 1508786385
Provider Name (Legal Business Name): ERICA LONG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E DIEHL RD STE 440
NAPERVILLE IL
60563-1358
US

IV. Provider business mailing address

20255 S GREENFIELD LN
FRANKFORT IL
60423-8925
US

V. Phone/Fax

Practice location:
  • Phone: 630-225-7519
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: