Provider Demographics
NPI:1457894131
Name:LINDEN, PETER KEENAN
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KEENAN
Last Name:LINDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 FERRIS PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3611
Mailing Address - Country:US
Mailing Address - Phone:718-730-1004
Mailing Address - Fax:718-892-6469
Practice Address - Street 1:1420 FERRIS PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3611
Practice Address - Country:US
Practice Address - Phone:718-730-1004
Practice Address - Fax:718-892-6469
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091629-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker