Healthcare Provider Details

I. General information

NPI: 1881630168
Provider Name (Legal Business Name): JANICE M LONG LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE M PRECOPIO

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WALL ST SUITE 300
MANCHESTER NH
03101-1518
US

IV. Provider business mailing address

401 CYPRESS ST
MANCHESTER NH
03103-3628
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-4111
  • Fax: 603-628-7757
Mailing address:
  • Phone: 603-668-4111
  • Fax: 603-628-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number533
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number533
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: