Provider Demographics
NPI:1962975649
Name:LONG, JESSICA A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5527
Mailing Address - Country:US
Mailing Address - Phone:717-991-4582
Mailing Address - Fax:
Practice Address - Street 1:20 ERFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1163
Practice Address - Country:US
Practice Address - Phone:717-730-8555
Practice Address - Fax:717-730-4566
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0197811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical