Healthcare Provider Details

I. General information

NPI: 1205886454
Provider Name (Legal Business Name): LINDA P VAN ESSENDELFT LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 PARK ST CAPE COD HOSPITAL PSYCH CENTER
HYANNIS MA
02601
US

IV. Provider business mailing address

121 AZALEA DR
HARWICH MA
02645-1721
US

V. Phone/Fax

Practice location:
  • Phone: 508-862-5566
  • Fax: 508-775-1598
Mailing address:
  • Phone: 508-432-8353
  • Fax: 508-432-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number100070
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: