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General NPI Number Information
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NPI Number | 1801019021
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Entity Type | Individual
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Provider Name | PETER FRANCIS LONG PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 950 WADSWORTH BLVD SUITE 304
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City | LAKEWOOD
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State | CO
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Zip | 80214-4542
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Country | US
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Telephone | 303-232-9102
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Fax | 303-232-9074
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Provider Business Mailing Address
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Address Line | 950 WADSWORTH BLVD SUITE 304
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City | LAKEWOOD
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State | CO
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Zip | 80214-4542
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Country | US
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Telephone | 303-232-9102
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Fax | 303-232-9074
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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 | 1216
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License Number State | CO
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