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General NPI Number Information
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NPI Number | 1598875692
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Entity Type | Organization
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Legal Business Name | PORT JEFFERSON PSYCHOLOGICAL & VOCATIONAL P.C.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/22/2017
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Provider Practice Location Address
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Address Line | 5225-46 ROUTE 347
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2060
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Country | US
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Telephone | 631-928-4635
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Fax | 631-928-4784
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Provider Business Mailing Address
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Address Line | 5225-46 ROUTE 347
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2060
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Country | US
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Telephone | 631-928-4635
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Fax | 631-928-4784
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Authorized Official
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Title or Position | OWNER
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Name | SARAH C LONG
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Credential | PSY.D.
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Telephone | 631-928-4635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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