MEDICARE: LINDA L LONGSERRE LMFT, LPCC

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	43138	CA
2	101YM0800X	Mental Health Counselor	LPC132	CA

General Provider Information

NPI Number	:	1477697001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA L LONGSERRE LMFT, LPCC

Provider Business Mailing Address
First Line	:	1000 FREMONT AVE STE 202
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3225
Country	:	US
Telephone Number	:	626-319-0705
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 FREMONT AVE STE 202
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3225
Country	:	US
Telephone Number	:	626-319-0705
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/02/2016

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