Provider Demographics
NPI:1114070281
Name:CERVENY, LINDA ANN (MSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:CERVENY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3857 N PASEO DE LAS CANCHAS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1082
Mailing Address - Country:US
Mailing Address - Phone:520-325-0635
Mailing Address - Fax:520-742-0050
Practice Address - Street 1:6812 N ORACLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4246
Practice Address - Country:US
Practice Address - Phone:520-325-0635
Practice Address - Fax:520-742-0050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-22711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ78632Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER