Provider Demographics
NPI:1447310867
Name:KRUPP, LINDA (MSW,LICSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KRUPP
Suffix:
Gender:F
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 WARE ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1540
Mailing Address - Country:US
Mailing Address - Phone:617-628-3535
Mailing Address - Fax:617-628-5222
Practice Address - Street 1:39 WARE ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1540
Practice Address - Country:US
Practice Address - Phone:617-628-7986
Practice Address - Fax:617-628-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1068731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA663701OtherHARVARDPILGRIM
MAP04356OtherBCBS INDIVIDUAL PROVIDER
MA043116637-001OtherCONSOLIDATEDHEALTHPLAN
MAP23348Medicare ID - Type UnspecifiedINDIVIDUALPROVIDER