Individual provider Active NPI

Jacqueline E Long, LCSW

  • Clinical Social Worker
  • Tulsa, OK
National Provider Identifier
1689876757
Registry record updated Oct 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Practice address
4103 S Yale Ave Ste B
Tulsa, OK 74135-6002
Phone
(918) 382-7300
NPI assigned
Jun 1, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X OK Primary

Addresses

Primary practice location

4103 S Yale Ave Ste B
Tulsa, OK 74135-6002

Mailing address

4103 S Yale Ave Ste B
Tulsa, OK 74135-6002
Phone (918) 382-7300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231116000135 OK Practitioner - Clinical Social Worker 3375990146 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4775OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Creoks Mental Health Services CurrentSince Sep 6, 2023 Accepting new patients
Creoks Mental Health Services Current Accepting new patients
Creoks Mental Health Services CurrentSince Sep 6, 2023 Accepting new patients

Locations

2548 E Kenosha St
Broken Arrow, OK 74014
Phone (918) 355-0993

4103 S Yale Ave
Ste B
Tulsa, OK 74135
Phone (918) 382-7302

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1689876757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 S YALE AVE STE B",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356002",
            "telephone_number": "918-382-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4103 S YALE AVE STE B",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741356002",
            "telephone_number": "918-382-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "JACQUELINE",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.