Provider Demographics
NPI:1740346881
Name:CROKE-DIPIETRO, LINDA LEE (LICSW)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEE
Last Name:CROKE-DIPIETRO
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 1:66 CLIFTON AVE
Mailing Address - Street 2:STE 7
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1737
Mailing Address - Country:US
Mailing Address - Phone:781-631-8273
Mailing Address - Fax:781-631-7264
Practice Address - Street 1:533 MAIN ST
Practice Address - Street 2:STE 7
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3858
Practice Address - Country:US
Practice Address - Phone:781-665-0998
Practice Address - Fax:781-665-0006
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA105721OtherLICSW