Provider Demographics
NPI:1962557413
Name:LINDER, LIZA (LSW)
Entity type:Individual
Prefix:MS
First Name:LIZA
Middle Name:
Last Name:LINDER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4123
Mailing Address - Country:US
Mailing Address - Phone:215-563-0663
Mailing Address - Fax:215-563-0664
Practice Address - Street 1:1201 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4123
Practice Address - Country:US
Practice Address - Phone:215-563-0663
Practice Address - Fax:215-563-0664
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015614101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health