Provider Demographics
NPI:1417164740
Name:FUTTERMAN, LINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:FUTTERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MR
Other - First Name:STANLEY
Other - Middle Name:
Other - Last Name:FUTTERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLB
Mailing Address - Street 1:17 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3709
Mailing Address - Country:US
Mailing Address - Phone:914-834-2056
Mailing Address - Fax:
Practice Address - Street 1:17 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3709
Practice Address - Country:US
Practice Address - Phone:914-834-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004197OtherLICENSE