1659060200 NPI number — MS. CAROLYNN MARISSA DELONG MSPSY

Table of content: MS. CAROLYNN MARISSA DELONG MSPSY (NPI 1659060200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659060200 NPI number — MS. CAROLYNN MARISSA DELONG MSPSY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELONG
Provider First Name:
CAROLYNN
Provider Middle Name:
MARISSA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSPSY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659060200
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2311 LILLY RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINERVA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44657-8764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6071 CANTON RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44615-9336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-312-3747
Provider Business Practice Location Address Fax Number:
330-863-7171
Provider Enumeration Date:
05/01/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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