Provider Demographics
NPI:1578925947
Name:ESCOLL, LINDA SHANE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SHANE
Last Name:ESCOLL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2404
Mailing Address - Country:US
Mailing Address - Phone:617-623-5956
Mailing Address - Fax:
Practice Address - Street 1:120 CURTIS ST, COUNSELING AND MENTAL HEALTH SERVICE
Practice Address - Street 2:TUFTS UNIVERSITY
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:617-627-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7109103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical