Provider Demographics
NPI:1679587414
Name:TATAR, LINDA MARCOTTE (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARCOTTE
Last Name:TATAR
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 1:3043 STATE ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-9632
Mailing Address - Country:US
Mailing Address - Phone:518-747-2284
Mailing Address - Fax:518-747-2253
Practice Address - Street 1:3043 STATE ROUTE 4
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-9632
Practice Address - Country:US
Practice Address - Phone:518-747-2284
Practice Address - Fax:518-747-2253
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000254951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00078673Medicaid
11645159OtherCAQH
P01225491OtherMEDICARE RAIL ROAD
53088OtherMVP
00400166001OtherHEALTHNOW INTEGRATED
NY00078673Medicaid