MEDICARE: LINDA S MICHAEL PSY. 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	PSY25655	CA

General Provider Information

NPI Number	:	1679608871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA S MICHAEL PSY. D.

Provider Business Mailing Address
First Line	:	1260 LAKE BLVD
Second Line	:	SUITE 224
City	:	DAVIS
State	:	CA
Zip	:	95616-2614
Country	:	US
Telephone Number	:	510-847-2982
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 LAKE BLVD
Second Line	:	SUITE 224
City	:	DAVIS
State	:	CA
Zip	:	95616-2614
Country	:	US
Telephone Number	:	510-847-2982
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	03/26/2017

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