Provider Demographics
NPI:1013032309
Name:HARDIN, LINDA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:LASALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29645 RANCHO CALIF RD #238
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-698-3242
Mailing Address - Fax:951-308-1515
Practice Address - Street 1:29645 RANCHO CALIF RD #238
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-693-0708
Practice Address - Fax:951-308-1515
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS10802104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ32550ZMedicare ID - Type Unspecified
R21355Medicare UPIN