Provider Demographics
NPI:1295732162
Name:CLEMENT, LINDA B (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:B
Last Name:CLEMENT
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 1:415 N MCKINLEY ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3013
Mailing Address - Country:US
Mailing Address - Phone:501-663-4331
Mailing Address - Fax:501-663-1335
Practice Address - Street 1:415 N MCKINLEY ST
Practice Address - Street 2:SUITE 430
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3013
Practice Address - Country:US
Practice Address - Phone:501-663-4331
Practice Address - Fax:501-663-1335
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2008-12-19
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
AR1008C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S740Medicare PIN