| Entity Name: | JAMIE LONG, PSY.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Jan 2013 (12 years ago) |
| Document Number: | P13000007843 |
| FEI/EIN Number | 46-1855749 |
| Address: | 2601 E Oakland Park Boulevard, SUITE 502, FT LAUDERDALE, FL, 33306, US |
| Mail Address: | 2601 E Oakland Park Boulevard, SUITE 502, FT LAUDERDALE, FL, 33306, US |
| ZIP code: | 33306 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841538824 | 2013-01-24 | 2013-01-24 | 2425 E COMMERCIAL BLVD STE 400, FT LAUDERDALE, FL, 333084029, US | 2425 E COMMERCIAL BLVD STE 400, FT LAUDERDALE, FL, 333084029, US | |||||||||||||||||||
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| Phone | +1 954-661-6847 |
| Fax | 9546345360 |
Authorized person
| Name | DR. JAMIE LONG |
| Role | PRESIDENT |
| Phone | 9546616847 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY7730 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMIE LONG, PSY.D., P.A. 401(K) PLAN | 2023 | 461855749 | 2024-05-08 | JAMIE LONG, PSY.D., P.A. | 5 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-08 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 9544882933 |
| Plan sponsor’s address | 2601 E OAKLAND PARK BLVD, SUITE 502, FT LAUDERDALE, FL, 33306 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-30 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Scicluna JAMIE | Agent | 2601 E Oakland Park Boulevard, FT LAUDERDALE, FL, 33306 |
| Name | Role | Address |
|---|---|---|
| Scicluna JAMIE | President | 2601 E Oakland Park Boulevard, FT LAUDERDALE, FL, 33306 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000048252 | DR. JAMIE LONG, FORT LAUDERDALE PSYCHOLOGIST | ACTIVE | 2020-05-01 | 2025-12-31 | No data | 2601 E OAKLAND PARK BLVD., SUITE 502, FORT LAUDERDALE, FL, 33304 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-09 | 2601 E Oakland Park Boulevard, SUITE 502, FT LAUDERDALE, FL 33306 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-09 | 2601 E Oakland Park Boulevard, SUITE 502, FT LAUDERDALE, FL 33306 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-09 | 2601 E Oakland Park Boulevard, SUITE 502, FT LAUDERDALE, FL 33306 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-03-01 | Scicluna, JAMIE | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-03-13 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-02-12 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-03-01 |
| ANNUAL REPORT | 2016-05-11 |
| ANNUAL REPORT | 2015-03-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
