MEDICARE: LINDA A WILK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	075928-1	NY
2	1041C0700X	Clinical Social Worker	080522-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080522-1	OTHER	NY	NYS OFFICE OF THE PROFESSIONS
2	075928-1	OTHER	NY	STATE LIC.

General Provider Information

NPI Number	:	1336303320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA A WILK LCSW

Provider Business Mailing Address
First Line	:	9 WILLARD WAY
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-7826
Country	:	US
Telephone Number	:	631-252-3588
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 WILLARD WAY
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-7826
Country	:	US
Telephone Number	:	631-252-3588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	03/28/2013

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