Individual
MS. JEANNE ALTHEA LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
106 W WINDHORST RD, BRANDON, FL 33510-2455
(813) 690-1461
Mailing address
1311 VERSANT DRIVE APT 203, BRANDON, FL 33511
(813) 690-1461
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW7896
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060297300
PENDING
FL
Enumeration date
11/09/2007
Last updated
04/13/2015
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