Provider Demographics
NPI:1205002060
Name:LONG, JANET KATHERINE
Entity Type:Individual
Prefix:PROF
First Name:JANET
Middle Name:KATHERINE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:K
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT ATR BC
Mailing Address - Street 1:743 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4439
Mailing Address - Country:US
Mailing Address - Phone:831-521-9287
Mailing Address - Fax:831-644-0881
Practice Address - Street 1:743 MARTIN ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4439
Practice Address - Country:US
Practice Address - Phone:831-521-9287
Practice Address - Fax:831-644-0881
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22322106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist