Provider Demographics
NPI:1093936296
Name:BEDERMAN, LINDA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:BEDERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 67TH AVE APT 3H
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4957
Mailing Address - Country:US
Mailing Address - Phone:917-679-6528
Mailing Address - Fax:
Practice Address - Street 1:10705 70TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4300
Practice Address - Country:US
Practice Address - Phone:917-679-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0749581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0064ARMedicare ID - Type Unspecified
NY981906Medicare UPIN