Provider Demographics
NPI:1902170772
Name:EMERSON, LINDA VARNETT (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:VARNETT
Last Name:EMERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:VARNETT
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:1066 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2250
Mailing Address - Country:US
Mailing Address - Phone:419-526-5523
Mailing Address - Fax:
Practice Address - Street 1:1066 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2250
Practice Address - Country:US
Practice Address - Phone:419-526-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0792411041C0700X
NCC0077131041C0700X
OHI 13029461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY079241OtherNEW YORK STATE LICENSURE BOARD - L.C.S.W.
NY1331779OtherNEW YORK STATE DEPT OF EDUCATION PERMANENT SCHOOL SOCIAL WORKER
OHI 1302946OtherL.I.S.W.
NC6009103Medicaid
OHH221750OtherMEDICARE PTAN
NCC007713OtherNORTH CAROLINA LICENSURE BOARD - L.C.S.W.