Healthcare Provider Details

I. General information

NPI: 1699758243
Provider Name (Legal Business Name): LINDA A STUBBLEFIELD M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WEBSTER PL
BROOKLINE MA
02445-7937
US

IV. Provider business mailing address

241 PERKINS ST J101
BOSTON MA
02130-4002
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9289
  • Fax:
Mailing address:
  • Phone: 617-232-9289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: