Provider Demographics
NPI:1750438347
Name:WARD, LINDA GAVAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:GAVAN
Last Name:WARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6700
Mailing Address - Country:US
Mailing Address - Phone:518-377-2377
Mailing Address - Fax:
Practice Address - Street 1:2310 NOTT ST E
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4303
Practice Address - Country:US
Practice Address - Phone:518-372-6080
Practice Address - Fax:518-372-6081
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009782103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01189326Medicaid
NY01189326Medicaid