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General NPI Number Information
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NPI Number | 1700924826
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Entity Type | Individual
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Provider Name | ESTELA (ESTELITA) M LONG PSY. D.
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Gender | Female
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/17/2016
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Provider Practice Location Address
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Address Line | 4020 SUN CITY CENTER BLVD. SUITE 11
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-5256
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Country | US
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Telephone | 813-634-4700
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Fax | 813-634-4703
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Provider Business Mailing Address
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Address Line | 934 CYPRESS VILLAGE BLVD STE A
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City | RUSKIN
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State | FL
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Zip | 33573-6832
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Country | US
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Telephone | 813-634-4700
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Fax | 813-634-4703
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY 6533
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License Number State | FL
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