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NPI Code Detail

MEDICARE: MS. LISA JOY LONG LCSW-C

MEDICARE: MS. LISA JOY LONG LCSW-C
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
11041C0700XClinical Social Worker12602MD

General Provider Information

NPI Number : 1942363429
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA JOY LONG LCSW-C
Provider Business Mailing Address
First Line : 12003 CREGGER RD
Second Line :
City : KEYMAR
State : MD
Zip : 21757-8131
Country : US
Telephone Number : 301-325-7989
Fax Number :
Provider Business Practice Location Address
First Line : 11670 OLD NATIONAL PIKE STE 103
Second Line :
City : NEW MARKET
State : MD
Zip : 21774-6123
Country : US
Telephone Number : 301-865-2226
Fax Number : 301-865-6720
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 11/10/2021

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