Healthcare Provider Details

I. General information

NPI: 1093936296
Provider Name (Legal Business Name): LINDA LEE BEDERMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10705 70TH AVE
FOREST HILLS NY
11375-4300
US

IV. Provider business mailing address

9850 67TH AVE APT 3H
REGO PARK NY
11374-4957
US

V. Phone/Fax

Practice location:
  • Phone: 917-679-6528
  • Fax:
Mailing address:
  • Phone: 917-679-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number074958
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: