Provider Demographics
NPI:1215261391
Name:LONG, LYNETTE ALBERTA (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNETTE
Middle Name:ALBERTA
Last Name:LONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 802
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-654-8181
Mailing Address - Fax:202-462-7680
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 802
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:301-654-8181
Practice Address - Fax:202-462-7680
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD1744102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst