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General NPI Number Information
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NPI Number | 1730485137
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Entity Type | Individual
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Provider Name | LINDA LIFUR-BENNETT PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 22772 CENTRE DR SUITE 180
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City | LAKE FOREST
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State | CA
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Zip | 92630-6303
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Country | US
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Telephone | 949-215-0066
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Fax | 949-215-0077
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Provider Business Mailing Address
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Address Line | 31 CHERRY HILLS DR
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City | COTO DE CAZA
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State | CA
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Zip | 92679-4746
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Country | US
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Telephone | 949-215-0066
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Fax | 949-215-0077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY8562
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License Number State | CA
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