Provider Demographics
NPI:1558662445
Name:LONG, COLLEEN F (PSYD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:F
Last Name:LONG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 SUMMER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1275
Mailing Address - Country:US
Mailing Address - Phone:781-287-8676
Mailing Address - Fax:800-593-2560
Practice Address - Street 1:50 MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864-2281
Practice Address - Country:US
Practice Address - Phone:781-287-8676
Practice Address - Fax:800-593-2560
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23911103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TH0004X
MA10295103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth