Provider Demographics
NPI:1134242944
Name:LINK, CARMA JEAN (MSW)
Entity type:Individual
Prefix:MRS
First Name:CARMA
Middle Name:JEAN
Last Name:LINK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5397
Mailing Address - Country:US
Mailing Address - Phone:260-438-1039
Mailing Address - Fax:260-488-3551
Practice Address - Street 1:2200 LAKE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5397
Practice Address - Country:US
Practice Address - Phone:260-438-1039
Practice Address - Fax:260-488-3551
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003526A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical