Healthcare Provider Details

I. General information

NPI: 1548563513
Provider Name (Legal Business Name): LINDA EILEEN KELLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 COLLEGE AVE #201
OAKLAND CA
94618-1598
US

IV. Provider business mailing address

5435 COLLEGE AVE #201
OAKLAND CA
94618-1598
US

V. Phone/Fax

Practice location:
  • Phone: 510-654-2420
  • Fax: 510-893-0247
Mailing address:
  • Phone: 510-654-2420
  • Fax: 510-893-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 7350
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY 7350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: