Provider Demographics
NPI:1336206473
Name:LONG, PAULIANN (LCSW-C)
Entity type:Individual
Prefix:
First Name:PAULIANN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 TSCHIFFELY SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5741
Mailing Address - Country:US
Mailing Address - Phone:240-447-0131
Mailing Address - Fax:
Practice Address - Street 1:528 TSCHIFFELY SQUARE RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5741
Practice Address - Country:US
Practice Address - Phone:240-447-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125191041C0700X
VA0904006672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health