Provider Information for 1215066105
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JENNIFER LINARELLO LCSW
Sex: Female
NPI: 1215066105
Last Updated: 2012-10-18
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1215066105 | ||||||||||||
| Enumeration Date | 2007-03-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | PO BOX 809 GOSHEN, IN 46527-0809 United States Phone: 574-533-1234 | Fax:574-537-2652 | ||||||||||||
| Primary Practice Address | 415 E MADISON ST SOUTH BEND, IN 46617-2322 United States Phone: 574-533-1234 | Fax:574-537-2652 | ||||||||||||
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