Provider Demographics
NPI:1194709287
Name:LININGER, LAURA DIANE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:DIANE
Last Name:LININGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:DIANE
Other - Last Name:CRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:101 WEST KIRKWOOD AVE
Mailing Address - Street 2:FOUNTAIN SQUARE, SUITE 218
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402
Mailing Address - Country:US
Mailing Address - Phone:812-327-6842
Mailing Address - Fax:812-676-9351
Practice Address - Street 1:101 WEST KIRKWOOD AVE
Practice Address - Street 2:FOUNTAIN SQUARE, SUITE 218
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47402
Practice Address - Country:US
Practice Address - Phone:812-327-6842
Practice Address - Fax:812-676-9351
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003425A101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000192037OtherANTHEM
INM400019385Medicare PIN