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NPI Code Detail

MEDICARE: MS. JEANNE ALTHEA LONG LCSW

MEDICARE: MS. JEANNE ALTHEA LONG LCSW
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
1104100000XSocial WorkerSW7896FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1060297300OTHERFLPENDING

General Provider Information

NPI Number : 1184804924
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JEANNE ALTHEA LONG LCSW
Provider Business Mailing Address
First Line : 1311 VERSANT DRIVE APT 203
Second Line :
City : BRANDON
State : FL
Zip : 33511
Country : US
Telephone Number : 813-690-1461
Fax Number :
Provider Business Practice Location Address
First Line : 106 W WINDHORST RD
Second Line :
City : BRANDON
State : FL
Zip : 33510-2455
Country : US
Telephone Number : 813-690-1461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2007
Last Update Date : 04/13/2015

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