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General NPI Number Information
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NPI Number | 1093524738
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Entity Type | Individual
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Provider Name | MS. LINDA C BACON
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 570 N BROAD ST
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City | ELIZABETH
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State | NJ
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Zip | 07208-3314
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Country | US
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Telephone | 973-355-0050
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Fax |
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Provider Business Mailing Address
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Address Line | 606 HIGHLAND AVE
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City | NEPTUNE
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State | NJ
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Zip | 07753-3508
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Country | US
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Telephone | 908-618-4814
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00769900
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License Number State | NJ
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