Provider Demographics
NPI:1972643732
Name:LIN, AUSTIN S (LICSW, LMT, RYT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:S
Last Name:LIN
Suffix:
Gender:M
Credentials:LICSW, LMT, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2506
Mailing Address - Country:US
Mailing Address - Phone:617-331-9723
Mailing Address - Fax:
Practice Address - Street 1:8 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2506
Practice Address - Country:US
Practice Address - Phone:617-331-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1158881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8176OtherLMT
MA115888OtherLICSW
MA426321OtherDOE-LICENSED SCHOOL SOCIAL WORKER