Healthcare Provider Details

I. General information

NPI: 1265443733
Provider Name (Legal Business Name): LINDA KATHLEEN STROM LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W RIVER RD
BRATTLEBORO VT
05301-9088
US

IV. Provider business mailing address

79 MAIN ST SUITE 104
FRAMINGHAM MA
01702-2945
US

V. Phone/Fax

Practice location:
  • Phone: 802-380-9900
  • Fax:
Mailing address:
  • Phone: 508-626-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107037
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: