Provider Demographics
NPI:1487670014
Name:MITTENTHAL, LINDA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:S
Last Name:MITTENTHAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:UPADHYAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1544
Mailing Address - Country:US
Mailing Address - Phone:860-236-1927
Mailing Address - Fax:860-236-6484
Practice Address - Street 1:333 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-1544
Practice Address - Country:US
Practice Address - Phone:860-236-1927
Practice Address - Fax:860-236-6484
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0052731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO1422Medicare ID - Type UnspecifiedAGENCY MEDICARE PROVIDER