Provider Demographics
NPI:1326481680
Name:DEMO, LINDA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:DEMO
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:PO BOX 412503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2503
Mailing Address - Country:US
Mailing Address - Phone:603-742-9200
Mailing Address - Fax:
Practice Address - Street 1:15 OLD ROLLINSFORD RD STE 302
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2819
Practice Address - Country:US
Practice Address - Phone:603-742-9200
Practice Address - Fax:603-742-4605
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC14024101YM0800X, 101YS0200X
NH16981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3090633Medicaid