Provider Demographics
NPI:1710434816
Name:LONG, LATANYA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:LATANYA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 W BROWARD BLVD STE 203-2007
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1314
Mailing Address - Country:US
Mailing Address - Phone:954-709-3996
Mailing Address - Fax:833-514-1516
Practice Address - Street 1:2630 W BROWARD BLVD STE 203-2007
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1314
Practice Address - Country:US
Practice Address - Phone:954-466-2469
Practice Address - Fax:833-514-1516
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-17-25956103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst