Provider Demographics
NPI:1174559488
Name:HENDRICKSON, LINDA RUTH (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:RUTH
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:RUTH
Other - Last Name:HAUER-HENDRICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:917 MAY LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:143 LOG CANOE CIR
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2127
Practice Address - Country:US
Practice Address - Phone:410-604-1277
Practice Address - Fax:410-604-1310
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111331041C0700X
TNLSW 00000039311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64207301OtherAPS HEALTHCARE
MD64207301OtherBLUE CROSS BLUE SHIELD MD
MD2130496OtherUNITED BEHAVIORAL HEALTHC
MD7228642OtherAETNA
MD516251OtherVALUE OPTIONS
MDP83117Medicare UPIN
MD516251OtherVALUE OPTIONS