Provider Demographics
NPI:1982733523
Name:CRITES, LINDA SORACE (CSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SORACE
Last Name:CRITES
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 HADEL DR
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1187
Mailing Address - Country:US
Mailing Address - Phone:443-253-1660
Mailing Address - Fax:410-549-2058
Practice Address - Street 1:2838 HADEL DR
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1187
Practice Address - Country:US
Practice Address - Phone:443-253-1660
Practice Address - Fax:410-549-2058
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD033271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00Q874Medicare Oscar/Certification
Q63691Medicare UPIN