Healthcare Provider Details

I. General information

NPI: 1609867969
Provider Name (Legal Business Name): LINDA C KOVACH L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 BONAR AVE
WAYNESBURG PA
15370-1604
US

IV. Provider business mailing address

1070 OLD NATIONAL PIKE
FREDERICKTOWN PA
15333-2114
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-8156
  • Fax:
Mailing address:
  • Phone: 724-632-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW009658L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: