Healthcare Provider Details

I. General information

NPI: 1689810871
Provider Name (Legal Business Name): LINDA MARIE-LATRONICA BULL LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA MARIE LATRONICA LLP

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W UNIVERSITY DR STE C
ROCHESTER MI
48307-1845
US

IV. Provider business mailing address

850 W UNIVERSITY DR STE C
ROCHESTER MI
48307-1845
US

V. Phone/Fax

Practice location:
  • Phone: 248-601-3111
  • Fax:
Mailing address:
  • Phone: 248-601-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number6301011942
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: