1528283595 NPI number — DR. LINDA A. JENKINS LCSW-R, PSYD, PHD

Table of content: DR. LINDA A. JENKINS LCSW-R, PSYD, PHD (NPI 1528283595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528283595 NPI number — DR. LINDA A. JENKINS LCSW-R, PSYD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENKINS
Provider First Name:
LINDA
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R, PSYD, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENKINS
Provider Other First Name:
LINDA
Provider Other Middle Name:
A.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-R
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528283595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10323 SPRINGFIELD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENS VILLAGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11429-2050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-977-3762
Provider Business Mailing Address Fax Number:
718-525-6902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10323 SPRINGFIELD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENS VILLAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11429-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-977-3762
Provider Business Practice Location Address Fax Number:
718-525-6902
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 102L00000X , with the licence number:  R-046371 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 135053 . This is a "VALUEOPTIONS PROVIDER#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7479339 . This is a "GHI PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: R-046371 . This is a "1199 PROVIDER#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N5H31 . This is a "BC-BS MEDICARE PROVIDER#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P670175 . This is a "OXFORD PROVIDER#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7582088 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01719406 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: NYS046371 . This is a "CARE MANAGEMENT GROUP #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: R-046371 . This is a "CLINICAL SOC. WORK LIC#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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