Provider Demographics
NPI:1831294941
Name:WEISBERG, LINDA (LICSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WEISBERG
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 1:18 GOULD RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2121
Mailing Address - Country:US
Mailing Address - Phone:617-965-0718
Mailing Address - Fax:
Practice Address - Street 1:63 FOUNTAIN ST STE 402
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6280
Practice Address - Country:US
Practice Address - Phone:508-872-4813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01420Medicare PIN