Provider Demographics
NPI:1013454388
Name:LINDA A MERTENS
Entity type:Organization
Organization Name:LINDA A MERTENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-377-7622
Mailing Address - Street 1:1813 CURRY TRAIL
Mailing Address - Street 2:
Mailing Address - City:N VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34275
Mailing Address - Country:US
Mailing Address - Phone:586-381-4345
Mailing Address - Fax:
Practice Address - Street 1:1813 CURRY TRL
Practice Address - Street 2:
Practice Address - City:NORTH VENICE
Practice Address - State:FL
Practice Address - Zip Code:34275-2962
Practice Address - Country:US
Practice Address - Phone:586-381-4345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty