Provider Demographics
NPI:1235882077
Name:LONG, ANDREA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 521
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-0521
Mailing Address - Country:US
Mailing Address - Phone:978-973-4026
Mailing Address - Fax:
Practice Address - Street 1:29 HUDSON RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1757
Practice Address - Country:US
Practice Address - Phone:978-973-4026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional