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Individual
JO MARY LONG
Active
Individual
JO MARY LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
1021707
MA
1041C0700X
Clinical Social Worker
Primary
1021707
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21079-7
BLUE CROSS/BLUE SHIELD RI
TN
01
—
406654
BLUE CHIP
RI
01
—
6207031
UNITED BEHAVIORAL HEALTH
MA
01
—
P06403
BLUE CROSS/BLUE SHIELD
MI
Enumeration date
10/11/2006
Last updated
04/02/2018
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