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General NPI Number Information
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NPI Number | 1174559488
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Entity Type | Individual
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Provider Name | LINDA RUTH HENDRICKSON LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 143 LOG CANOE CIR
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2127
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Country | US
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Telephone | 410-604-1277
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Fax | 410-604-1310
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Provider Business Mailing Address
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Address Line | 917 MAY LN
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2215
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11133
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW 0000003931
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License Number State | TN
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