Provider Demographics
NPI:1801957931
Name:SHEPARD SALZER, LINDA GAYLE (MA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:GAYLE
Last Name:SHEPARD SALZER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:GAYLE
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 WALTHAM STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8033
Mailing Address - Country:US
Mailing Address - Phone:781-862-3600
Mailing Address - Fax:781-863-5903
Practice Address - Street 1:1040 WALTHAM STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8033
Practice Address - Country:US
Practice Address - Phone:781-862-3600
Practice Address - Fax:781-863-5903
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA703136OtherTUFTS
99618201OtherNETWORK HLTH
MA1303287Medicaid
MAM18633OtherBCBS
MA1004745OtherNHP
MA1303287OtherMBHP
MANP01332OtherBMC
MAM18633OtherBCBS