Dr. Jack M. Long & Assoc., P.a.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

03068 Issued in MD

Legal business name

DR. JACK M. LONG & ASSOC., P.A.

Practice address

720 Maiden Choice LN
Suite C
Catonsville, MD 21228-5940

Phone

(410) 744-5499

Fax

(410) 455-0894

NPI assigned

Dec 13, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jack Martin Long, PH.D.NPI 1447296629

Title

Psychotherapist

Phone

(410) 744-5499

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack Martin Long, PH.D.

  • Clinical Social Worker
  • Catonsville, MD
  • NPI 1447296629
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1144599572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 MAIDEN CHOICE LN",
            "address_2": "SUITE C",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212285940",
            "telephone_number": "410-744-5499",
            "fax_number": "410-455-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 MAIDEN CHOICE LN",
            "address_2": "SUITE C",
            "city": "CATONSVILLE",
            "state": "MD",
            "postal_code": "212285940",
            "telephone_number": "410-744-5499",
            "fax_number": "410-455-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JACK M. LONG & ASSOC., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "410-744-5499",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "03068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE UNSPECIFIED",
            "identifier": "Q292JM",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FEDERAL",
            "identifier": "R7610001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "755011100",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "755011100",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "R7610001",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Catonsville, MD
• Providers in Catonsville, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.