Provider Demographics
NPI:1104398155
Name:GENDRON, LINDA MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:GENDRON
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 1:657 TROUVILLE AVE. #2
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433
Mailing Address - Country:US
Mailing Address - Phone:805-474-2165
Mailing Address - Fax:805-474-2160
Practice Address - Street 1:657 TROUVILLE AVE #2
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433
Practice Address - Country:US
Practice Address - Phone:805-474-2165
Practice Address - Fax:805-474-2160
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW73630104100000X
CALCSW99052104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
104100000XOtherBOARD OF BEHAVIORAL SCIENCE