Provider Demographics
NPI:1821504705
Name:GRATT, LINDA R (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:R
Last Name:GRATT
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 1:1241 ADAMS ST APT 307
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5767
Mailing Address - Country:US
Mailing Address - Phone:617-298-3094
Mailing Address - Fax:
Practice Address - Street 1:1241 ADAMS ST APT 307
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5767
Practice Address - Country:US
Practice Address - Phone:617-298-3094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060421041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty