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General NPI Number Information
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NPI Number | 1821104522
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Entity Type | Individual
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Provider Name | LINDA M ERCOLI PH.D
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 07/16/2024
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Provider Practice Location Address
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Address Line | 760 WESTWOOD PLZ STE 38-239
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City | LOS ANGELES
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State | CA
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Zip | 90024-5055
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Country | US
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Telephone | 310-825-9208
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD SUITE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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Country | US
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Telephone | 310-825-9989
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Fax |
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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 | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | PSY15935
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY15935
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License Number State | CA
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