Provider Demographics
NPI:1073386843
Name:LONG TERM HEALING, PLLC
Entity Type:Organization
Organization Name:LONG TERM HEALING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:PURA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:845-313-7824
Mailing Address - Street 1:36 LEATHERSTOCKING LN
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:NH
Mailing Address - Zip Code:03237-5030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 LEATHERSTOCKING LN
Practice Address - Street 2:
Practice Address - City:GILMANTON
Practice Address - State:NH
Practice Address - Zip Code:03237-5030
Practice Address - Country:US
Practice Address - Phone:845-313-7824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty