Provider Demographics
NPI:1821187964
Name:THEMA, LINDA PRENTICE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:PRENTICE
Last Name:THEMA
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 1:909 TAMIAMI TRL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3180
Mailing Address - Country:US
Mailing Address - Phone:941-483-4393
Mailing Address - Fax:941-480-0565
Practice Address - Street 1:909 TAMIAMI TRL
Practice Address - Street 2:SUITE 110
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3180
Practice Address - Country:US
Practice Address - Phone:941-483-4393
Practice Address - Fax:941-480-0565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 31201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00035170Medicare ID - Type Unspecified
FLR03760Medicare UPIN