Provider Demographics
NPI:1811038698
Name:MCCRELESS, LINDA F (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:F
Last Name:MCCRELESS
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 1:2764 WHITNEY AVE FL 2D
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2504
Mailing Address - Country:US
Mailing Address - Phone:203-507-5229
Mailing Address - Fax:866-543-6657
Practice Address - Street 1:2764 WHITNEY AVE FL 2D
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2504
Practice Address - Country:US
Practice Address - Phone:203-507-5229
Practice Address - Fax:866-543-6657
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
800004370Medicare UPIN