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General NPI Number Information
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NPI Number | 1184804924
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Entity Type | Individual
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Provider Name | JEANNE ALTHEA LONG LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 106 W WINDHORST RD
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City | BRANDON
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State | FL
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Zip | 33510-2455
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Country | US
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Telephone | 813-690-1461
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Fax |
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Provider Business Mailing Address
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Address Line | 1311 VERSANT DRIVE APT 203
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-690-1461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW7896
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License Number State | FL
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