Provider Demographics
NPI:1922363639
Name:LINTON, OPAL DAWN (MS, ED)
Entity Type:Individual
Prefix:
First Name:OPAL
Middle Name:DAWN
Last Name:LINTON
Suffix:
Gender:F
Credentials:MS, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 W 123RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5400
Mailing Address - Country:US
Mailing Address - Phone:646-678-1723
Mailing Address - Fax:
Practice Address - Street 1:248 W 123RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5400
Practice Address - Country:US
Practice Address - Phone:646-678-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1160960252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency