Healthcare Provider Details

I. General information

NPI: 1740347384
Provider Name (Legal Business Name): LINDA COMENITZ GELDA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ALBAN RD
WABAN MA
02468-1934
US

IV. Provider business mailing address

45 ALBAN RD
WABAN MA
02468-1934
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-1735
  • Fax: 617-630-9309
Mailing address:
  • Phone: 617-332-1735
  • Fax: 617-630-9309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107122
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: