MEDICARE: JESSIE CARABALLO-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	104100000X	Social Worker
2	104100000X	Social Worker	S.2411098	OH

General Provider Information

NPI Number	:	1871480491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE CARABALLO-LONG

Provider Business Mailing Address
First Line	:	3551 W 146TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 W 146TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3108
Country	:	US
Telephone Number	:	440-623-8349
Fax Number	:

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

Provider Enumeration Date	:	06/18/2025
Last Update Date	:	06/18/2025

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Directions to “ JESSIE CARABALLO-LONG ” Practice Location

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