Provider Demographics
NPI:1245537679
Name:LONG, CARMELLA M (LCSW-C)
Entity type:Individual
Prefix:
First Name:CARMELLA
Middle Name:M
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7668
Mailing Address - Country:US
Mailing Address - Phone:313-850-7119
Mailing Address - Fax:
Practice Address - Street 1:3707 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-7668
Practice Address - Country:US
Practice Address - Phone:313-850-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD183521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical