Healthcare Provider Details

I. General information

NPI: 1558662445
Provider Name (Legal Business Name): COLLEEN F. LONG PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MAIN ST STE 201
NORTH READING MA
01864-2281
US

IV. Provider business mailing address

161 SUMMER ST STE 5
KINGSTON MA
02364-1275
US

V. Phone/Fax

Practice location:
  • Phone: 781-287-8676
  • Fax: 800-593-2560
Mailing address:
  • Phone: 781-287-8676
  • Fax: 800-593-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23911
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY23911
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY23911
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number10295
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY23911
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY23911
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10295
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: