Provider Demographics
NPI:1619623758
Name:LONG, MAUREEN N (CDCA II)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:N
Last Name:LONG
Suffix:
Gender:F
Credentials:CDCA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 MIDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2786
Mailing Address - Country:US
Mailing Address - Phone:440-723-8997
Mailing Address - Fax:440-822-3716
Practice Address - Street 1:174 MIDWAY BLVD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2786
Practice Address - Country:US
Practice Address - Phone:440-723-8997
Practice Address - Fax:440-822-3716
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.184144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)