Provider Demographics
NPI:1528283595
Name:JENKINS, LINDA A (LCSW-R, PSYD, PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW-R, PSYD, PHD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:A
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:10323 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2050
Mailing Address - Country:US
Mailing Address - Phone:718-977-3762
Mailing Address - Fax:718-525-6902
Practice Address - Street 1:10323 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2050
Practice Address - Country:US
Practice Address - Phone:718-977-3762
Practice Address - Fax:718-525-6902
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-046371102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY135053OtherVALUEOPTIONS PROVIDER#
NY7479339OtherGHI PROVIDER #
NYR-046371Other1199 PROVIDER#
NYN5H31OtherBC-BS MEDICARE PROVIDER#
NYP670175OtherOXFORD PROVIDER#
NY7582088OtherAETNA PROVIDER #
NY01719406Medicaid
NYNYS046371OtherCARE MANAGEMENT GROUP #
NYR-046371OtherCLINICAL SOC. WORK LIC#
NYP670175OtherOXFORD PROVIDER#
NY02330Medicare UPIN