Provider Demographics
NPI:1497030985
Name:LINEHAN, MEREDITH BOLDEN (LICSW; MPA)
Entity Type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:BOLDEN
Last Name:LINEHAN
Suffix:
Gender:F
Credentials:LICSW; MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SUMMER ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3075
Mailing Address - Country:US
Mailing Address - Phone:781-258-1645
Mailing Address - Fax:
Practice Address - Street 1:80 SUMMER ST APT 3
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3075
Practice Address - Country:US
Practice Address - Phone:781-258-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1165341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical