Provider Demographics
NPI:1922330588
Name:GRANT, LINDA E (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:GRANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:E
Other - Last Name:YUTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:123 WOOLEYS LN
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2342
Mailing Address - Country:US
Mailing Address - Phone:718-224-0566
Mailing Address - Fax:718-224-7544
Practice Address - Street 1:5820 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2530
Practice Address - Country:US
Practice Address - Phone:718-224-0566
Practice Address - Fax:718-224-7544
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0772851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY077285OtherLICENSED CLINICAL SOCIAL WORK
NY01382663Medicaid