Provider Demographics
NPI:1376014688
Name:LONG, DANA (LMFT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LMFT
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 433
Mailing Address - Street 2:
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-0433
Mailing Address - Country:US
Mailing Address - Phone:844-365-7676
Mailing Address - Fax:844-365-7676
Practice Address - Street 1:140 S BROADWAY STE 7
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-2235
Practice Address - Country:US
Practice Address - Phone:844-365-7676
Practice Address - Fax:844-365-7676
Is Sole Proprietor?:No
Enumeration Date:2018-12-13
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional