Provider Demographics
NPI:1750432514
Name:DEBERARD, LINDA MILLER (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MILLER
Last Name:DEBERARD
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 1:6210 PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-6011
Mailing Address - Country:US
Mailing Address - Phone:817-909-1820
Mailing Address - Fax:817-348-8791
Practice Address - Street 1:1205 HALL JOHNSON BLVD #8
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034
Practice Address - Country:US
Practice Address - Phone:817-909-1820
Practice Address - Fax:817-348-8791
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX057521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical