Basic Information
| Provider Information | |||||||||
| NPI: | 1699983866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONTORELLI | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 RUSS ST | ||||||||
| Address2: | |||||||||
| City: | METHUEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018445952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787941619 | ||||||||
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| Practice Location | |||||||||
| Address1: | 687 HIGHLAND AVE | ||||||||
| Address2: | 3RD FL, SUITE 16 | ||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024942232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004558726 | ||||||||
| FaxNumber: | 8664558839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1018393 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1890409 | 05 | MA | MEDICAID |