Provider Demographics
NPI:1336306414
Name:JENKINS, LINDA T (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:T
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:T
Other - Last Name:CLUKIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:31 JOHN CLARKE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5641
Mailing Address - Country:US
Mailing Address - Phone:401-849-2300
Mailing Address - Fax:
Practice Address - Street 1:31 JOHN CLARKE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5641
Practice Address - Country:US
Practice Address - Phone:401-849-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-17
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW013621041C0700X
MA1104171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical