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NPI Code Detail

MEDICARE: MARIETTA LONG

MEDICARE: MARIETTA LONG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician26-539742FL

General Provider Information

NPI Number : 1013845395
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIETTA LONG
Provider Business Mailing Address
First Line : 1333 S MAYFLOWER AVE STE 220
Second Line :
City : MONROVIA
State : CA
Zip : 91016-5239
Country : US
Telephone Number : 818-241-6780
Fax Number : 888-588-2752
Provider Business Practice Location Address
First Line : 3210 CORRINE DR
Second Line :
City : ORLANDO
State : FL
Zip : 32803-2230
Country : US
Telephone Number : 855-295-3276
Fax Number : 888-588-2752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2026
Last Update Date : 05/26/2026

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Directions to “ MARIETTA LONG ” Practice Location

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