Provider Demographics
NPI:1336303320
Name:WILK, LINDA A (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:WILK
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 1:9 WILLARD WAY
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7826
Mailing Address - Country:US
Mailing Address - Phone:631-252-3588
Mailing Address - Fax:
Practice Address - Street 1:9 WILLARD WAY
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-7826
Practice Address - Country:US
Practice Address - Phone:631-252-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075928-11041C0700X
NY080522-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080522-1OtherNYS OFFICE OF THE PROFESSIONS
NY075928-1OtherSTATE LIC.