Provider Demographics
NPI:1265431985
Name:DWINELL, LINDA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:DWINELL
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 1:961 TOWHEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32305-8409
Mailing Address - Country:US
Mailing Address - Phone:850-421-6325
Mailing Address - Fax:
Practice Address - Street 1:3840 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-2196
Practice Address - Country:US
Practice Address - Phone:850-514-1929
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW40191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8316Medicare ID - Type UnspecifiedINDIVIDUAL