Provider Demographics
NPI:1891905543
Name:MISA, LINDA HARMAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:HARMAN
Last Name:MISA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LINDA-LU
Other - Middle Name:
Other - Last Name:MISA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2725 PARK DR STE 5
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1023
Mailing Address - Country:US
Mailing Address - Phone:727-365-3554
Mailing Address - Fax:
Practice Address - Street 1:2725 PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1023
Practice Address - Country:US
Practice Address - Phone:727-365-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 27001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4168Medicare ID - Type UnspecifiedSOCIAL WORKER