Provider Demographics
NPI:1447330683
Name:KACZOR, LINDA M (PHD, MS)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:KACZOR
Suffix:
Gender:F
Credentials:PHD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1797
Mailing Address - Country:US
Mailing Address - Phone:781-854-2826
Mailing Address - Fax:
Practice Address - Street 1:167 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1797
Practice Address - Country:US
Practice Address - Phone:781-854-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6175103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1992025506OtherAETNA
MA1992025506OtherCIGNA
MA6100969OtherEVERCARE PROVIDER NUMBER
MA814620000OtherMAGELLAN PROVIDER NUMBER
MA1992025506OtherUNITED BEHAVIORAL
MAW04975OtherBCBS PROVIDER NUMBER
MA1992025506OtherUNITED BEHAVIORAL