Healthcare Provider Details

I. General information

NPI: 1609095686
Provider Name (Legal Business Name): LINDA RUTH BRACKIN MSS, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ADAMS DAM RD
GREENVILLE DE
19807-1438
US

IV. Provider business mailing address

701 ADAMS DAM RD
GREENVILLE DE
19807-1438
US

V. Phone/Fax

Practice location:
  • Phone: 302-888-2345
  • Fax:
Mailing address:
  • Phone: 302-888-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberQ10000282
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: