Provider Demographics
NPI:1760588321
Name:LONG, SUSAN ELIZABETH (LMHC, NP, APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:LONG
Suffix:
Gender:F
Credentials:LMHC, NP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 DERBY ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-3728
Mailing Address - Country:US
Mailing Address - Phone:781-374-4100
Mailing Address - Fax:
Practice Address - Street 1:62 DERBY ST
Practice Address - Street 2:SUITE 11
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3728
Practice Address - Country:US
Practice Address - Phone:781-374-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4054101YM0800X
MA267712363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854986Medicaid
MA000189601Medicare UPIN