Provider Demographics
NPI:1295416717
Name:LONG, PHOEBE EDGERTON (PHD)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:EDGERTON
Last Name:LONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 WISCONSIN AVE NW STE 400
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2055
Mailing Address - Country:US
Mailing Address - Phone:202-363-1010
Mailing Address - Fax:
Practice Address - Street 1:5225 WISCONSIN AVE NW STE 400
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2055
Practice Address - Country:US
Practice Address - Phone:202-363-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008528103T00000X
DCPSY200001635103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist