Provider Demographics
NPI:1184768673
Name:MELNICK, LINDA (LCSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MELNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 BLANCO RIVER PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2860
Mailing Address - Country:US
Mailing Address - Phone:512-689-5728
Mailing Address - Fax:
Practice Address - Street 1:MOBILE LOCATION
Practice Address - Street 2:TRAVIS COUNTY
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-2860
Practice Address - Country:US
Practice Address - Phone:512-689-5728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12989104100000X, 1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090GBOtherBLUE CROSS BLUE SHEILD
TX00S96NOtherBLUE CROSS BLUE SHEILD
TX1083180-03Medicaid
TX108318001Medicaid