Provider Demographics
NPI:1184608317
Name:HERMAN, LINDA JANE (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JANE
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:JANE
Other - Last Name:MILLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:30 GREENWICH AVE
Mailing Address - Street 2:GFB
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:646-486-3260
Mailing Address - Fax:208-978-2465
Practice Address - Street 1:30 GREENWICH AVE
Practice Address - Street 2:GFB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:646-486-3260
Practice Address - Fax:208-978-2465
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW0037991041C0700X
NY0037991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NG3531Medicare UPIN
NYN10501Medicare ID - Type Unspecified