Provider Demographics
NPI:1699758243
Name:STUBBLEFIELD, LINDA A (MSW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 PERKINS ST
Mailing Address - Street 2:J101
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4002
Mailing Address - Country:US
Mailing Address - Phone:617-232-9289
Mailing Address - Fax:
Practice Address - Street 1:40 WEBSTER PL
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7937
Practice Address - Country:US
Practice Address - Phone:617-232-9289
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1044631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA05296000OtherMAGELLAN
MA171479OtherMAGELLAN
MA171479OtherMAGELLAN
MAPO2718Medicare ID - Type Unspecified