=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093507048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E. EUGENE DELONG, PH.D. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2025
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 W LIBERTY ST STE 363
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17603-2798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-606-2904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 W LIBERTY ST STE 363
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17603-2798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-606-2904
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EARL EUGENE DELONG
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 717-606-2904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------