Provider Demographics
NPI:1720073513
Name:TRUM, LINDA C (LICSW PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:C
Last Name:TRUM
Suffix:
Gender:F
Credentials:LICSW PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PERKINS ST
Mailing Address - Street 2:052
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4313
Mailing Address - Country:US
Mailing Address - Phone:617-477-3654
Mailing Address - Fax:617-477-3836
Practice Address - Street 1:111 PERKINS ST
Practice Address - Street 2:052
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4313
Practice Address - Country:US
Practice Address - Phone:617-477-3654
Practice Address - Fax:617-477-3836
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-17
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1005801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA424232OtherHARVARD PILGRIM
MA752064OtherTUFTS
MATR P01626OtherBLUE CROSSBLUE SHIELD
MD007858OtherVALUE OPTIONS
MA1004655OtherBEACON
MA1004655OtherBEACON