Provider Demographics
NPI:1316393085
Name:LONG, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4162
Mailing Address - Country:US
Mailing Address - Phone:954-344-6550
Mailing Address - Fax:954-344-8634
Practice Address - Street 1:7410 BOYNTON BEACH BLVD STE B1
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-6157
Practice Address - Country:US
Practice Address - Phone:561-223-1650
Practice Address - Fax:561-484-5091
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist