Long, Jack Martin

Long, Jack Martin is an sole proprietor health care provider with primary practice located at 720C Maiden Choice Ln , Catonsville MD 21228-5940. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Long, Jack Martin can be contacted via phone (410) 744-5499.

Contact Information

Primary practice address
720C Maiden Choice Ln Catonsville MD 21228-5940
Phone: (410) 744-5499
Fax: (410) 455-0894
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 03068 Maryland

Profile Details

NPI number 1447296629
LBN Legal business name Long, Jack Martin
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 22nd, 2006
Last updated Dec 12th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447296629 NPPES
Maryland MEDICAID 755011100
Maryland Other R7610001
Maryland Other Q292JM
Maryland Other R7610001
Maryland Other 276629

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