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General NPI Number Information
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NPI Number | 1104398155
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Entity Type | Individual
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Provider Name | LINDA MARIE GENDRON LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/31/2018
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 657 TROUVILLE AVE #2
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City | GROVER BEACH
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State | CA
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Zip | 93433
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Country | US
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Telephone | 805-474-2165
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Fax | 805-474-2160
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Provider Business Mailing Address
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Address Line | 657 TROUVILLE AVE. #2
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City | GROVER BEACH
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State | CA
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Zip | 93433
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Country | US
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Telephone | 805-474-2165
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Fax | 805-474-2160
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW73630
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCSW99052
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License Number State | CA
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