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General NPI Number Information
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NPI Number | 1528619038
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Entity Type | Organization
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Legal Business Name | LINDA S MITTENTHAL LCSW LLC
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 1738 ELLINGTON RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2773
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Country | US
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Telephone | 860-614-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 1738 ELLINGTON RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2773
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Country | US
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Telephone | 860-614-0842
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | LINDA SUSAN MITTENTHAL
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Credential | LCSW
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Telephone | 860-517-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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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 |
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License Number State |
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