Healthcare Provider Details

I. General information

NPI: 1568438901
Provider Name (Legal Business Name): LINDA R. PURETZ MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 HALCYON RD
NEWTON MA
02459-2432
US

IV. Provider business mailing address

28 HALCYON RD
NEWTON MA
02459-2432
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-0493
  • Fax: 617-964-2675
Mailing address:
  • Phone: 617-243-0493
  • Fax: 617-964-2675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100513
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: