MEDICARE: DR. LINDA DOLORES ANDERSON 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	101YM0800X	Mental Health Counselor	7520	NY

General Provider Information

NPI Number	:	1528462793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA DOLORES ANDERSON PH.D

Provider Business Mailing Address
First Line	:	784 COLUMBUS AVE APT 5P
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5916
Country	:	US
Telephone Number	:	917-873-0223
Fax Number	:

Provider Business Practice Location Address
First Line	:	784 COLUMBUS AVE APT 5P
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5916
Country	:	US
Telephone Number	:	917-873-0223
Fax Number	:

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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