Individual
DR. MICHAEL THOMAS LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
255 S 17TH ST STE 804, PHILADELPHIA, PA 19103-6208
(720) 339-5526
Mailing address
255 S 17TH ST STE 804, PHILADELPHIA, PA 19103-6208
(203) 339-5526
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS018844
PA
Other
Enumeration date
09/27/2019
Last updated
05/04/2024
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