Provider Demographics
NPI:1679601231
Name:MCDANIEL, LINDA (SW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 LOMAS BLVD NE
Mailing Address - Street 2:MANZANO HS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5804
Mailing Address - Country:US
Mailing Address - Phone:505-559-2200
Mailing Address - Fax:
Practice Address - Street 1:12200 LOMAS BLVD NE
Practice Address - Street 2:MANZANO HS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5804
Practice Address - Country:US
Practice Address - Phone:505-559-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 6105104100000X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27757722Medicaid