MEDICARE: DR. LINDA C TRUM LICSW PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	100580	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	424232	OTHER	MA	HARVARD PILGRIM
2	752064	OTHER	MA	TUFTS
3	TR P01626	OTHER	MA	BLUE CROSSBLUE SHIELD
4	007858	OTHER	MD	VALUE OPTIONS
5	1004655	OTHER	MA	BEACON

General Provider Information

NPI Number	:	1720073513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA C TRUM LICSW PHD

Provider Business Mailing Address
First Line	:	111 PERKINS ST APT 52
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4320
Country	:	US
Telephone Number	:	781-871-6084
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 PERKINS ST APT 52
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-4320
Country	:	US
Telephone Number	:	781-871-6084
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2005
Last Update Date	:	09/05/2025

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