Provider Demographics
NPI:1801039532
Name:NUGEN, LINDA SUSAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:SUSAN
Last Name:NUGEN
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 1:17046 MARYGOLD AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-1722
Mailing Address - Country:US
Mailing Address - Phone:909-427-5128
Mailing Address - Fax:909-427-6268
Practice Address - Street 1:17046 MARYGOLD AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-1722
Practice Address - Country:US
Practice Address - Phone:909-427-5128
Practice Address - Fax:909-427-6268
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2021-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS152661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical