Provider Demographics
NPI:1356515514
Name:PELOSI, LINDA ANN (R-LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:PELOSI
Suffix:
Gender:F
Credentials:R-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 SAGAMORE HILLS DR
Mailing Address - Street 2:PORT JEFFERSON STATION
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3556
Mailing Address - Country:US
Mailing Address - Phone:631-828-1670
Mailing Address - Fax:
Practice Address - Street 1:220 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3504
Practice Address - Country:US
Practice Address - Phone:631-874-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR031781-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical