Provider Demographics
NPI:1174867311
Name:HERBERTSON, LYNDA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:HERBERTSON
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 1:6045 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2347
Mailing Address - Country:US
Mailing Address - Phone:412-854-0672
Mailing Address - Fax:
Practice Address - Street 1:6045 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-2347
Practice Address - Country:US
Practice Address - Phone:412-854-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0173051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical