Healthcare Provider Details

I. General information

NPI: 1811034663
Provider Name (Legal Business Name): KEITH LINTON LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11515 SUTPHIN BLVD
JAMAICA NY
11434-1020
US

IV. Provider business mailing address

1272 E 91ST ST
BROOKLYN NY
11236-4256
US

V. Phone/Fax

Practice location:
  • Phone: 718-659-4000
  • Fax:
Mailing address:
  • Phone: 718-251-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: