Individual
MARY P LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
510 4TH ST S, PRAIRIE ST JOHNS, FARGO, ND 58103
(701) 476-7200
(701) 476-7273
Mailing address
3411 FIECHTNER DR S, FARGO, ND 58103
(701) 476-7200
(701) 476-7273
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2469
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153K1L0
BCBS
MN
Enumeration date
09/20/2006
Last updated
07/08/2007
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