MEDICARE: MS. LINDA CAROL FODRINI-JOHNSON MFT

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	101YM0800X	Mental Health Counselor	MFC28401	CA

General Provider Information

NPI Number	:	1437269875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA CAROL FODRINI-JOHNSON MFT

Provider Business Mailing Address
First Line	:	1808 TICE VALLEY BLVD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-2224
Country	:	US
Telephone Number	:	925-256-0527
Fax Number	:	925-945-1720

Provider Business Practice Location Address
First Line	:	1808 TICE VALLEY BLVD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-2224
Country	:	US
Telephone Number	:	925-256-0527
Fax Number	:	925-945-1720

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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