Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY23911 | CA |
N | 103T00000X | Psychologist | PSY23911 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY23911 | CA |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 10295 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY23911 | CA |
N | 103G00000X | Clinical Psychologist | 10295 | MA |
N | 103TC0700X | Clinical Psychologist | 10295 | MA |
N | 103G00000X | Clinical Psychologist | PSY23911 | CA |
N | 103TC0700X | Clinical Psychologist | PSY23911 | CA |
N | 103TH0004X | Health Psychologist | PSY23911 | CA |
NPI | 1558662445 |
---|---|
Provider Name | Dr. Colleen F. Long |
First Address | Duxbury, MA 02332-4131 |
Second Address | North Reading, MA 01864-2281 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2010 |
Last Update Date | 21/11/2017 |