MEDICARE: BRUCE LINTON M.A. PH.D. 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	106H00000X	Marriage & Family Therapist	MFT 14092	CA

General Provider Information

NPI Number	:	1831200716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE LINTON M.A. PH.D. MFT

Provider Business Mailing Address
First Line	:	1521A SHATTUCK AVE STE 201
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-1516
Country	:	US
Telephone Number	:	510-644-0300
Fax Number	:	510-845-8530

Provider Business Practice Location Address
First Line	:	1521A SHATTUCK AVE STE 201
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94709-1516
Country	:	US
Telephone Number	:	510-644-0300
Fax Number	:	510-845-8530

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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