Provider Demographics
NPI:1750112660
Name:LONG, LYNNETTE MARIE (DOCTORATE)
Entity type:Individual
Prefix:DR
First Name:LYNNETTE
Middle Name:MARIE
Last Name:LONG
Suffix:
Gender:F
Credentials:DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5657 E WASHINGTON BLVD # 1583
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1405
Mailing Address - Country:US
Mailing Address - Phone:951-858-7224
Mailing Address - Fax:951-858-7224
Practice Address - Street 1:9840 1/2 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5956
Practice Address - Country:US
Practice Address - Phone:951-858-7224
Practice Address - Fax:951-858-7224
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral