Provider Demographics
NPI:1568438901
Name:PURETZ, LINDA R (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:PURETZ
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HALCYON RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2432
Mailing Address - Country:US
Mailing Address - Phone:617-243-0493
Mailing Address - Fax:617-964-2675
Practice Address - Street 1:28 HALCYON RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2432
Practice Address - Country:US
Practice Address - Phone:617-243-0493
Practice Address - Fax:617-964-2675
Is Sole Proprietor?:No
Enumeration Date:2006-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1005131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical