=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699811927
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDA PADROFF LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2505 CARMEL AVE SUITE 210
-----------------------------------------------------
City | BREWSTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10509-1122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-279-5994
-----------------------------------------------------
Fax | 845-279-7678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 N BEECH TREE RD
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06804-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-279-5994
-----------------------------------------------------
Fax | 845-279-7678
-----------------------------------------------------
=====================================================
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 | R044115-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 003920
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------