Organization
COMMONWEALTH FAMILY PSYCHOLOGICAL ASSOCIATES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVAN MARK LONGIN ED.D. (PRESIDENT)
(978) 744-5006
Entity
Organization
Contact information
Practice address
204 LAFAYETTE ST, SALEM, MA 01970-4721
(978) 744-5006
(978) 744-9799
Mailing address
204 LAFAYETTE ST, SALEM, MA 01970-4721
(978) 744-5006
(978) 744-9799
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
702714
TUFTS HEALTH PLAN
MA
01
—
W10108
BCBS OF MA
MA
Enumeration date
10/26/2006
Last updated
08/22/2020
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