MEDICARE: DR. LINDA SUE NAGEL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	012585	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	179562	OTHER	NY	MHN PROVIDER ID
2	P636912	OTHER	NY	OXFORD PROVIDER ID

General Provider Information

NPI Number	:	1194871418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA SUE NAGEL PH.D.

Provider Business Mailing Address
First Line	:	275 6TH AVE
Second Line	:	APT. 1
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2531
Country	:	US
Telephone Number	:	718-788-9243
Fax Number	:	212-385-2380

Provider Business Practice Location Address
First Line	:	164 ARGYLE RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3402
Country	:	US
Telephone Number	:	917-816-1335
Fax Number	:	212-385-2380

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	07/08/2007

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