| Dr. Jack M. Long & Assoc., P.a. | |
|
720 Maiden Choice Ln Suite C Catonsville MD 21228-5940 | |
| (410) 744-5499 | |
| (410) 455-0894 |
| Full Name | Dr. Jack M. Long & Assoc., P.a. |
|---|---|
| Speciality | Social Worker |
| Location | 720 Maiden Choice Ln, Catonsville, Maryland |
| Authorized Official Name and Position | Jack Martin Long (PSYCHOTHERAPIST) |
| Authorized Official Contact | 4107445499 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Jack M. Long & Assoc., P.a. 720 Maiden Choice Ln Suite C Catonsville MD 21228-5940 Ph: (410) 744-5499 | Dr. Jack M. Long & Assoc., P.a. 720 Maiden Choice Ln Suite C Catonsville MD 21228-5940 Ph: (410) 744-5499 |
| NPI Number | 1144599572 |
|---|---|
| Provider Enumeration Date | 12/13/2011 |
| Last Update Date | 12/13/2011 |
| Medicare PECOS PAC ID | 6709050099 |
|---|---|
| Medicare Enrollment ID | O20111123000244 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144599572 | NPI | - | NPPES |
| Q292JM | Other | MD | MEDICARE UNSPECIFIED |
| R7610001 | Other | MD | BCBS FEDERAL |
| 755011100 | Other | MD | MAMSI |
| 755011100 | Medicaid | MD | |
| R7610001 | Other | MD | BLUE CHOICE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 03068 (Maryland) | Primary |
| Provider Name | Jack M Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447296629 PECOS PAC ID: 7517131808 Enrollment ID: I20111220000746 |
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