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General NPI Number Information
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NPI Number | 1841538824
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Entity Type | Organization
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Legal Business Name | JAMIE LONG, PSY.D., P.A.
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 2425 E COMMERCIAL BLVD STE 400
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4029
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Country | US
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Telephone | 954-661-6847
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Fax | 954-634-5360
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Provider Business Mailing Address
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Address Line | 2425 E COMMERCIAL BLVD STE 400
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-4029
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Country | US
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Telephone | 954-661-6847
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Fax | 954-634-5360
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMIE LONG
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Credential |
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Telephone | 954-661-6847
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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 | PY7730
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License Number State | FL
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