Healthcare Provider Details

I. General information

NPI: 1376507236
Provider Name (Legal Business Name): LINDA ZOE PODBROS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 COTTAGE ST
SHARON MA
02067-2133
US

IV. Provider business mailing address

84 COTTAGE ST
SHARON MA
02067-2133
US

V. Phone/Fax

Practice location:
  • Phone: 781-784-1739
  • Fax: 781-784-9488
Mailing address:
  • Phone: 781-784-1739
  • Fax: 781-784-9488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number3416
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: