Healthcare Provider Details

I. General information

NPI: 1336206473
Provider Name (Legal Business Name): PAULIANN LONG LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 TSCHIFFELY SQUARE RD
GAITHERSBURG MD
20878-5741
US

IV. Provider business mailing address

528 TSCHIFFELY SQUARE RD
GAITHERSBURG MD
20878-5741
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-0131
  • Fax:
Mailing address:
  • Phone: 240-447-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904006672
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12519
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: