MEDICARE: CAITLIN MARIE 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
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	292612	KY

General Provider Information

NPI Number	:	1770234163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN MARIE LONG

Provider Business Mailing Address
First Line	:	4276 HEGNER AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-3615
Country	:	US
Telephone Number	:	513-276-7697
Fax Number	:

Provider Business Practice Location Address
First Line	:	4276 HEGNER AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-3615
Country	:	US
Telephone Number	:	513-276-7697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	06/24/2024

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Directions to “ CAITLIN MARIE LONG ” Practice Location

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