Provider Demographics
NPI:1720702863
Name:DEPRADO, LINDA LYNDSI (MHC)
Entity Type:Individual
Prefix:
First Name:LINDA LYNDSI
Middle Name:
Last Name:DEPRADO
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 MAITLAND CENTER COMMONS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7434
Mailing Address - Country:US
Mailing Address - Phone:407-776-0958
Mailing Address - Fax:
Practice Address - Street 1:1059 MAITLAND CENTER COMMONS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7434
Practice Address - Country:US
Practice Address - Phone:407-776-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21096101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health