Provider Demographics
NPI:1336210715
Name:LARRATT, LINDA M (LICSW MSW)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:LARRATT
Suffix:
Gender:F
Credentials:LICSW MSW
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1033
Mailing Address - Street 2:442 KING ST
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-0633
Mailing Address - Country:US
Mailing Address - Phone:978-952-0150
Mailing Address - Fax:978-952-6322
Practice Address - Street 1:442 KING ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:MA
Practice Address - Zip Code:01460-0633
Practice Address - Country:US
Practice Address - Phone:978-952-0150
Practice Address - Fax:978-952-6322
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019612104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP22326Medicare ID - Type Unspecified
P06348Medicare UPIN