Ajasha Maxine Long, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY12271 Issued in FL

Practice address

14540 Old Saint Augustine Rd Ste 2591
Jacksonville, FL 32258-7420

Phone

(904) 376-3800

Fax

(904) 390-7405

NPI assigned

Apr 13, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Metrohealth System

  • Multi-Specialty Clinic/Center
  • Cleveland, OH
  • NPI 1053353896
  NPD
• The Metrohealth System

  • General Acute Care Hospital
  • Cleveland, OH
  • NPI 1700828852
  NPD
• The Metrohealth System

  • Pharmacy
  • Cleveland, OH
  • NPI 1992529911
  NPD
• Works of Faith Wellness and Consultation, LLC

  • Psychologist
  • Columbus, OH
  • NPI 1770184244
  NPD (past)

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

{
    "created_epoch": "1586736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1609495282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 METROHEALTH DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441091900",
            "telephone_number": "314-780-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14540 OLD SAINT AUGUSTINE RD STE 2591",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587420",
            "telephone_number": "904-376-3800",
            "fax_number": "904-390-7405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 Metrohealth Dr",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441091900",
            "country_code": "US",
            "telephone_number": "216-778-7800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "AJASHA",
        "middle_name": "MAXINE",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-13",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "OH",
            "license": "P.08309",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY12271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "along184000@direct.metrohealth.org",
            "affiliation": "N",
            "address_1": "2500 Metrohealth Dr",
            "city": "Cleveland",
            "state": "OH",
            "country_code": "US",
            "postal_code": "441091900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Beth London, OT
• Karyn London
• Morgan Z London, LMHC
• Theresa L London, RN
• Caitlin Marie Lonergan
• Andrea Long
• Ashley Renee Long
• Brittany O'Neal Long
• Evonne Marie Long, AUD
• Gary Long, PA

• Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.