MEDICARE: DR. LINDA JEAN DRUSCHEL PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MS20004	CA

General Provider Information

NPI Number	:	1164791661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA JEAN DRUSCHEL PH.D.

Provider Business Mailing Address
First Line	:	1345 GRIZZLY PEAK BLVD
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94708-2129
Country	:	US
Telephone Number	:	510-220-4217
Fax Number	:	510-845-5255

Provider Business Practice Location Address
First Line	:	1345 GRIZZLY PEAK BLVD
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94708-2129
Country	:	US
Telephone Number	:	510-220-4217
Fax Number	:	510-845-5255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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