Provider Demographics
NPI:1457737421
Name:SMALL, LINDA L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:SMALL
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:PO BOX 1125
Mailing Address - Street 2:
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-1125
Mailing Address - Country:US
Mailing Address - Phone:508-867-4491
Mailing Address - Fax:508-867-3555
Practice Address - Street 1:62 WARE ST
Practice Address - Street 2:
Practice Address - City:WEST BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01585-3136
Practice Address - Country:US
Practice Address - Phone:508-867-4491
Practice Address - Fax:508-867-3555
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1184831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical