Provider Demographics
NPI:1780879270
Name:PETERSON, LINDA LOWELL (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LOWELL
Last Name:PETERSON
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 1:864 WETHERSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-3184
Mailing Address - Country:US
Mailing Address - Phone:860-432-3309
Mailing Address - Fax:860-296-5939
Practice Address - Street 1:864 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-3184
Practice Address - Country:US
Practice Address - Phone:860-432-3309
Practice Address - Fax:860-296-5939
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-08
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical