Provider Demographics
NPI:1790908960
Name:ST. JOHN, LINDA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:ST. JOHN
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 1:295 WATCHOGUE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3159
Mailing Address - Country:US
Mailing Address - Phone:718-698-1402
Mailing Address - Fax:718-698-1402
Practice Address - Street 1:295 WATCHOGUE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3159
Practice Address - Country:US
Practice Address - Phone:718-698-1402
Practice Address - Fax:718-698-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0357021041C0700X
NJ44SC013849001041C0700X
NY6432821041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035702OtherLICENSE NO.
NJ44SC01384900OtherLICENSE NO.