Provider Demographics
NPI:1477683118
Name:PUERTAS, LINDA L (MSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:PUERTAS
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 1:109 23 71 RD.
Mailing Address - Street 2:#2D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4807
Mailing Address - Country:US
Mailing Address - Phone:718-575-9628
Mailing Address - Fax:718-575-9628
Practice Address - Street 1:109 23 7L RD.
Practice Address - Street 2:2D
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4807
Practice Address - Country:US
Practice Address - Phone:718-575-9628
Practice Address - Fax:718-575-9628
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028613-L1041C0700X
NYR028613-L LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1216LMedicare ID - Type Unspecified