=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235204728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA ELAINE WEINBAUM LCSW, BCD, ACSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 05/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3002 SE 1ST AVE BUILDING 100
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-0477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-610-0061
-----------------------------------------------------
Fax | 352-732-0455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3002 SE 1ST AVE BUILDING 100
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-0477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-610-0061
-----------------------------------------------------
Fax | 352-732-0455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6951
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW9590
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34000188A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------