Healthcare Provider Details

I. General information

NPI: 1336303320
Provider Name (Legal Business Name): LINDA A WILK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WILLARD WAY
DIX HILLS NY
11746-7826
US

IV. Provider business mailing address

9 WILLARD WAY
DIX HILLS NY
11746-7826
US

V. Phone/Fax

Practice location:
  • Phone: 631-252-3588
  • Fax:
Mailing address:
  • Phone: 631-252-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075928-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number080522-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier080522-1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNYS OFFICE OF THE PROFESSIONS
# 2
Identifier075928-1
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSTATE LIC.

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: