Provider Demographics
NPI:1932327301
Name:FUCONE, LINDA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:D
Last Name:FUCONE
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 1:506 N 4TH AVE
Mailing Address - Street 2:155 DANCING LIGHTS LANE
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1513
Mailing Address - Country:US
Mailing Address - Phone:208-561-1211
Mailing Address - Fax:208-265-2301
Practice Address - Street 1:506 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1513
Practice Address - Country:US
Practice Address - Phone:208-263-5393
Practice Address - Fax:208-265-2301
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-308701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW-30870OtherNEW LICENSE FOR STATE OF IDAHO
CASW20236Medicare PIN