Provider Demographics
NPI:1669984449
Name:BACINO, LINDA LOU (LCSW-R)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LOU
Last Name:BACINO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:BACINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QLCSW,LCSW-R
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-0287
Mailing Address - Country:US
Mailing Address - Phone:845-214-2705
Mailing Address - Fax:845-832-7888
Practice Address - Street 1:145 ROUTE 22
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-3214
Practice Address - Country:US
Practice Address - Phone:845-214-2705
Practice Address - Fax:845-832-7888
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0754381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical