Healthcare Provider Details

I. General information

NPI: 1205902459
Provider Name (Legal Business Name): LINDA K. MIHALEK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA K. RANSOM

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST
TOWANDA PA
18848-1803
US

IV. Provider business mailing address

RR 3 BOX 187
WYALUSING PA
18853-9573
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-2525
  • Fax: 570-265-1075
Mailing address:
  • Phone: 570-744-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014567
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1013037770001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: