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Individual

MR. J. DAVID LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSYCHOLOGIST DOCTORA

Contact information

Practice address
78 S MAIN ST, RUTLAND, VT 05701-4530
(802) 775-8224
(802) 747-7699
Mailing address
PO BOX 686, MIDDLEBURY, VT 05753-0686
(802) 352-9085

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0480000309
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9534
VT
01
9963
BC/BS
VT
Enumeration date
09/29/2006
Last updated
07/08/2007
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