Provider Demographics
NPI:1619210853
Name:LONG, ANDREA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:LONG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1570
Mailing Address - Country:US
Mailing Address - Phone:989-799-0066
Mailing Address - Fax:
Practice Address - Street 1:304 S NIAGARA ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-1570
Practice Address - Country:US
Practice Address - Phone:989-799-0066
Practice Address - Fax:989-799-6867
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010929641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical