Healthcare Provider Details

I. General information

NPI: 1912597469
Provider Name (Legal Business Name): JAMIE LONG L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 MORRISTOWN CORNERS RD
MORRISTOWN VT
05661-9245
US

IV. Provider business mailing address

1275 MOREN LOOP
MORRISTOWN VT
05661-8892
US

V. Phone/Fax

Practice location:
  • Phone: 802-585-5510
  • Fax:
Mailing address:
  • Phone: 802-825-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091.0134036
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: