Provider Demographics
NPI:1528239134
Name:LONG, DEBORAH LYNN (MSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:LONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 SOUTH STATE STREET
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DRIVE
Practice Address - Street 2:3RD FLOOR TAUBMAN CENTER RECP C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5360
Practice Address - Country:US
Practice Address - Phone:734-647-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-22
Last Update Date:2016-05-09
Deactivation Date:2013-05-28
Deactivation Code:
Reactivation Date:2016-04-18
Provider Licenses
StateLicense IDTaxonomies
MI68010777021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical