Provider Demographics
NPI:1134265705
Name:NELSON, LINDA (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:NELSON
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 1:14173 KEUKA VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:NY
Mailing Address - Zip Code:14837-9621
Mailing Address - Country:US
Mailing Address - Phone:607-377-2354
Mailing Address - Fax:607-292-6810
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1806
Practice Address - Country:US
Practice Address - Phone:607-377-2354
Practice Address - Fax:607-292-6810
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0783101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical