Individual
DR. JACK MARTIN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
720C MAIDEN CHOICE LN, CATONSVILLE, MD 21228-5940
(410) 744-5499
(410) 455-0894
Mailing address
720 MAIDEN CHOICE LN, SUITE C, CATONSVILLE, MD 21228-5940
(410) 744-5499
(410) 455-0894
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
03068
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
276629
MAMSI
MD
05
—
755011100
—
MD
01
—
Q292JM
BLUE CROSS/ BLUE SHIELD
MD
01
—
R7610001
BC/BS FEDERAL
MD
Enumeration date
06/22/2006
Last updated
12/12/2011
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