Provider Demographics
NPI:1407075120
Name:PENKOWER, LINDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:PENKOWER
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 1:311 W 24TH ST
Mailing Address - Street 2:SUITE 9G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1502
Mailing Address - Country:US
Mailing Address - Phone:917-599-8849
Mailing Address - Fax:
Practice Address - Street 1:311 W 24TH ST
Practice Address - Street 2:SUITE 9G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1502
Practice Address - Country:US
Practice Address - Phone:917-599-8849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035372-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN2671Medicare ID - Type Unspecified