Provider Demographics
NPI:1215013537
Name:PETERSON, LINDA M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:PETERSON
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 1:239 GREEN TREE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8408
Mailing Address - Country:US
Mailing Address - Phone:610-399-3168
Mailing Address - Fax:610-399-3168
Practice Address - Street 1:1224 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-7380
Practice Address - Country:US
Practice Address - Phone:610-399-3168
Practice Address - Fax:610-399-3168
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-001408-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0464557000OtherINDEPENDENCE BLUE CROSS
PA4213811OtherAETNA