Provider Demographics
NPI:1497764443
Name:LONG, LINDA NMI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:NMI
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
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 8141
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96162-8141
Mailing Address - Country:US
Mailing Address - Phone:530-587-1978
Mailing Address - Fax:530-582-1920
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:SUITE 360
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-587-1978
Practice Address - Fax:530-582-1920
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS98401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical