Provider Demographics
NPI:1255509824
Name:TANKS, LINDA M (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:TANKS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BLOOMFIELD AVE STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1242
Mailing Address - Country:US
Mailing Address - Phone:973-778-6174
Mailing Address - Fax:973-778-7727
Practice Address - Street 1:777 BLOOMFIELD AVE STE A
Practice Address - Street 2:SUITE A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1242
Practice Address - Country:US
Practice Address - Phone:973-778-6174
Practice Address - Fax:973-778-7727
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL053809001041C0700X
NY0737541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical