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General NPI Number Information
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NPI Number | 1356319784
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Entity Type | Individual
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Provider Name | LINDA C. TILLMON MSW
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 140 ERDMAN PL APT 15F
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City | BRONX
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State | NY
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Zip | 10475-5312
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Country | US
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Telephone | 646-423-8795
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Fax | 929-286-9775
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Provider Business Mailing Address
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Address Line | 2590 FRISBY AVE STE 104
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City | BRONX
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State | NY
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Zip | 10461-3240
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Country | US
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Telephone | 718-239-1610
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Fax | 718-792-7053
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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 | 069485
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License Number State | NY
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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 | 076822
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License Number State | NY
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