Provider Demographics
NPI:1457564726
Name:LONG, KELLY (MSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44360 HAMMOND SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43968-9776
Mailing Address - Country:US
Mailing Address - Phone:330-518-4556
Mailing Address - Fax:330-385-3588
Practice Address - Street 1:15303 ST. RT 170
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9216
Practice Address - Country:US
Practice Address - Phone:330-385-1000
Practice Address - Fax:330-385-3588
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor