Provider Demographics
NPI:1316267289
Name:LONG, CATHERINE EMELYN (EDD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:EMELYN
Last Name:LONG
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 LOWER MAIN STREET
Mailing Address - Street 2:RM# 207
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-298-6555
Mailing Address - Fax:808-242-8471
Practice Address - Street 1:1464 LOWER MAIN ST
Practice Address - Street 2:RM# 207
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1964
Practice Address - Country:US
Practice Address - Phone:808-298-6555
Practice Address - Fax:808-242-8471
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist