Provider Demographics
NPI:1932220787
Name:SARVIS, LINDA CORBETT (LCSW, LMT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CORBETT
Last Name:SARVIS
Suffix:
Gender:F
Credentials:LCSW, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3036 KALEB CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2515
Mailing Address - Country:US
Mailing Address - Phone:850-566-1639
Mailing Address - Fax:
Practice Address - Street 1:3201 SHAMROCK ST S STE 103
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3349
Practice Address - Country:US
Practice Address - Phone:850-566-1639
Practice Address - Fax:850-894-0062
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA23448225700000X
FLSW153581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist