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General NPI Number Information
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NPI Number | 1275254500
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Entity Type | Individual
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Provider Name | LYNN DIANE LONG PHD (C), APRN, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 357 E CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4472
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Country | US
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Telephone | 860-288-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 4809 AVONDALE RIDGE DR
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City | DUBLIN
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State | OH
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Zip | 43017-8623
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Country | US
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Telephone | 614-582-2542
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0032169
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License Number State | OH
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