Provider Demographics
NPI:1558479840
Name:COULTER, LINDA BLAIR (MSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:BLAIR
Last Name:COULTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2094 ALBANY POST RD
Mailing Address - Street 2:DOM 52
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548-1454
Mailing Address - Country:US
Mailing Address - Phone:914-737-4400
Mailing Address - Fax:914-788-4371
Practice Address - Street 1:2094 ALBANY POST RD
Practice Address - Street 2:DOM 52
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1454
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:914-788-4371
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07047811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical