Provider Demographics
NPI:1578987798
Name:LONG, CYNTHIA SMITH
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SMITH
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 1:50 TIMWAY RD
Mailing Address - Street 2:P.O. BOX 934
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-7069
Mailing Address - Country:US
Mailing Address - Phone:508-364-3144
Mailing Address - Fax:508-214-0236
Practice Address - Street 1:50 TIMWAY RD
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667-7069
Practice Address - Country:US
Practice Address - Phone:508-364-3144
Practice Address - Fax:508-214-0236
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker