Provider Demographics
NPI:1972745537
Name:HIMBERGER, LINDA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:HIMBERGER
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 1:60 FIRE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3502
Mailing Address - Country:US
Mailing Address - Phone:631-805-4227
Mailing Address - Fax:
Practice Address - Street 1:60 FIRE ISLAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3502
Practice Address - Country:US
Practice Address - Phone:631-805-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076561-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000835Medicare PIN