Healthcare Provider Details

I. General information

NPI: 1750599593
Provider Name (Legal Business Name): LIN SIE LINDSAY IP PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE SUITE 319
SAN JOSE CA
95128-2631
US

IV. Provider business mailing address

2400 MOORPARK AVE SUITE 319
SAN JOSE CA
95128-2631
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax: 408-975-2745
Mailing address:
  • Phone: 408-975-2730
  • Fax: 408-975-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: