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General NPI Number Information
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NPI Number | 1194215152
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Entity Type | Individual
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Provider Name | CALLIE REALTA LONG LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 18 CHURCH ST
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City | NORTH ATTLEBORO
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State | MA
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Zip | 02760-1625
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Country | US
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Telephone | 508-566-2636
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9120
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City | CHELSEA
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State | MA
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Zip | 02150-9120
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Country | US
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Telephone |
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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 | 226244
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License Number State | MA
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