Provider Demographics
NPI:1043647357
Name:WACHTEL, LINDA BENEZRA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:BENEZRA
Last Name:WACHTEL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:BENEZRA
Other - Last Name:WACHTEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:121 STONEHURST DR
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2946
Mailing Address - Country:US
Mailing Address - Phone:201-816-0996
Mailing Address - Fax:
Practice Address - Street 1:121 STONEHURST DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2946
Practice Address - Country:US
Practice Address - Phone:201-816-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027610251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health