Provider Demographics
NPI:1629899398
Name:LONG, KASEY LYNN (PEER SUPPORT SPECIAL)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:LYNN
Last Name:LONG
Suffix:
Gender:F
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 DUTCHMAN DR
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:DE
Mailing Address - Zip Code:19943-6122
Mailing Address - Country:US
Mailing Address - Phone:302-233-2077
Mailing Address - Fax:
Practice Address - Street 1:429 S NEW ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6715
Practice Address - Country:US
Practice Address - Phone:302-504-8500
Practice Address - Fax:302-306-6261
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist