Provider Demographics
NPI:1518116854
Name:LONG, JAMIE N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:N
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 1:2601 E OAKLAND PARK BLVD STE 502
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1617
Mailing Address - Country:US
Mailing Address - Phone:954-661-6847
Mailing Address - Fax:954-488-2912
Practice Address - Street 1:2601 E OAKLAND PARK BLVD STE 502
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1617
Practice Address - Country:US
Practice Address - Phone:954-661-6847
Practice Address - Fax:954-488-2912
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical