Healthcare Provider Details

I. General information

NPI: 1104270966
Provider Name (Legal Business Name): LINDA WESTBERRY FREDERIC LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA WESTBERRY LCSW

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1408 NW 101ST ST
MIAMI FL
33147-1853
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 786-537-1675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: