Healthcare Provider Details

I. General information

NPI: 1104097377
Provider Name (Legal Business Name): LINDA BROCKMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 SKYLAND DRIVE
ZEPHYR COVE NV
89448-3152
US

IV. Provider business mailing address

PO BOX 11152
ZEPHYR COVE NV
89448-3152
US

V. Phone/Fax

Practice location:
  • Phone: 530-318-5868
  • Fax:
Mailing address:
  • Phone: 530-318-5868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 270
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: