Healthcare Provider Details

I. General information

NPI: 1497985311
Provider Name (Legal Business Name): LINDA DEZIO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLOVE RD
STATEN ISLAND NY
10301-3627
US

IV. Provider business mailing address

800 AXINN AVE
GARDEN CITY NY
11530-2139
US

V. Phone/Fax

Practice location:
  • Phone: 718-816-6440
  • Fax: 718-420-2718
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number072384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: