Provider Demographics
NPI:1225054950
Name:GRIFFIN, LINDA GAYLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:GAYLE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:GAYLE
Other - Last Name:PANTALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:775 SUNRISE AVE
Mailing Address - Street 2:#120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4523
Mailing Address - Country:US
Mailing Address - Phone:916-622-0884
Mailing Address - Fax:
Practice Address - Street 1:775 SUNRISE AVE
Practice Address - Street 2:#120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4523
Practice Address - Country:US
Practice Address - Phone:916-622-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS58751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ86273ZMedicare ID - Type Unspecified