Provider Demographics
NPI:1083953657
Name:WOOTEN, LINDA THERESA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:THERESA
Last Name:WOOTEN
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 1:12 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01220-1936
Mailing Address - Country:US
Mailing Address - Phone:413-743-1547
Mailing Address - Fax:
Practice Address - Street 1:12 SMITH ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01220-1936
Practice Address - Country:US
Practice Address - Phone:413-743-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2013-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1146551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical