Provider Demographics
NPI:1891337010
Name:KING-BRONNER, LINDA D
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:D
Last Name:KING-BRONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHESTNUT ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2303
Mailing Address - Country:US
Mailing Address - Phone:585-262-4330
Mailing Address - Fax:
Practice Address - Street 1:33 CHESTNUT ST FL 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2303
Practice Address - Country:US
Practice Address - Phone:585-262-4330
Practice Address - Fax:585-262-4826
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)