Provider Demographics
NPI:1669512869
Name:NAZRYAN, LINDA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:NAZRYAN
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 1:107 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3531
Mailing Address - Country:US
Mailing Address - Phone:516-767-1655
Mailing Address - Fax:
Practice Address - Street 1:107 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3531
Practice Address - Country:US
Practice Address - Phone:516-767-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR027316-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical