Provider Demographics
NPI:1023009792
Name:CAVALLERO, LINDA M (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:CAVALLERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BOSTON TPKE STE 312
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3446
Mailing Address - Country:US
Mailing Address - Phone:508-845-2305
Mailing Address - Fax:508-845-2307
Practice Address - Street 1:415 BOSTON TPKE STE 312
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3446
Practice Address - Country:US
Practice Address - Phone:508-845-2305
Practice Address - Fax:508-845-2307
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3268103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0512745Medicaid
MACA W03351Medicare ID - Type Unspecified