Provider Demographics
NPI:1932471315
Name:LONG, JESSICA MARIE (MS, CGC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:SZYMANIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:PERELMAN CENTER FOR ADVANCED MEDICINE, 3 WEST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-2773
Mailing Address - Fax:215-349-5314
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:PERELMAN CENTER FOR ADVANCED MEDICINE, 3 WEST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-2773
Practice Address - Fax:215-349-5314
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS