Provider Demographics
NPI:1144247701
Name:MIGDOLE, LINDA CLAIRE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CLAIRE
Last Name:MIGDOLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4417
Mailing Address - Country:US
Mailing Address - Phone:978-922-2280
Mailing Address - Fax:978-927-1758
Practice Address - Street 1:23 BROADWAY
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4417
Practice Address - Country:US
Practice Address - Phone:978-922-2280
Practice Address - Fax:978-927-1758
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10166741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA901877OtherTUFTS
MA1302892Medicaid
MAPO4772OtherBLUE CROSS/BLUESHIELD
MA094958OtherMHN
MAPO4772Medicare ID - Type Unspecified
MA1302892Medicaid