Provider Demographics
NPI:1043700586
Name:STANISLAW, LINDA L (LMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:STANISLAW
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:SQUEGLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5300 S ATLANTIC AVE APT 17404
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-7524
Mailing Address - Country:US
Mailing Address - Phone:407-616-9866
Mailing Address - Fax:
Practice Address - Street 1:1340 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-1850
Practice Address - Country:US
Practice Address - Phone:407-616-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health