Provider Demographics
NPI:1548591233
Name:LONG, JEFFERY S (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:S
Last Name:LONG
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:3310 CROASDAILE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-6806
Mailing Address - Country:US
Mailing Address - Phone:919-384-9682
Mailing Address - Fax:919-384-9683
Practice Address - Street 1:3310 CROASDAILE DR STE 400
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-6806
Practice Address - Country:US
Practice Address - Phone:919-384-9682
Practice Address - Fax:919-384-9683
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2013-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC4306103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist