Provider Demographics
NPI:1831256395
Name:WIND, LINDA HERON (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:HERON
Last Name:WIND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:ANDERSON
Other - Last Name:PINCKNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:8042 MAIN STREET FISHERS
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8907
Mailing Address - Country:US
Mailing Address - Phone:585-924-5620
Mailing Address - Fax:585-924-5620
Practice Address - Street 1:8042 MAIN STREET FISHERS
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-8907
Practice Address - Country:US
Practice Address - Phone:585-924-5620
Practice Address - Fax:585-924-5620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007829-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7242413OtherAETNA PROVIDER NUMBER
NY100250FCOtherPREFERRED CARE PROVIDER N
NY7242413OtherAETNA PROVIDER NUMBER