MEDICARE: MR. CHRISTOPHER J 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
1	1041S0200X	School Social Worker	993601	FL
2	104100000X	Social Worker	SW8918	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z02Z3	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1982991469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER J LONG LCSW

Provider Business Mailing Address
First Line	:	9315 HUNTINGTON PARK WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2566
Country	:	US
Telephone Number	:	813-635-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 TECH BLVD STE 145
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-7845
Country	:	US
Telephone Number	:	813-635-6100
Fax Number	:

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

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	07/19/2023

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