Provider Demographics
NPI:1932965241
Name:LINDE, KIM (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:LINDE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MISS
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:HEPPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1100 JEFFERSON RD
Mailing Address - Street 2:STE 12 #1256
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623
Mailing Address - Country:US
Mailing Address - Phone:585-415-1096
Mailing Address - Fax:
Practice Address - Street 1:5625 YARROW ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2441
Practice Address - Country:US
Practice Address - Phone:585-415-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000910106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist