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General NPI Number Information
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NPI Number | 1659060200
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Entity Type | Individual
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Provider Name | CAROLYNN MARISSA DELONG MSPSY
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Gender | Female
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 6071 CANTON RD NW
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City | CARROLLTON
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State | OH
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Zip | 44615-9336
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Country | US
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Telephone | 330-312-3747
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Fax | 330-863-7171
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Provider Business Mailing Address
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Address Line | 2311 LILLY RD NW
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City | MINERVA
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State | OH
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Zip | 44657-8764
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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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 | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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