MEDICARE: DR. LINDA G. PELTZ 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	103TC0700X	Clinical Psychologist	005728	NY

General Provider Information

NPI Number	:	1629079785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA G. PELTZ PH.D.

Provider Business Mailing Address
First Line	:	366 N BROADWAY
Second Line	:	SUITE 404
City	:	JERICHO
State	:	NY
Zip	:	11753-2025
Country	:	US
Telephone Number	:	516-935-1610
Fax Number	:

Provider Business Practice Location Address
First Line	:	366 N BROADWAY
Second Line	:	SUITE 404
City	:	JERICHO
State	:	NY
Zip	:	11753-2025
Country	:	US
Telephone Number	:	516-935-1610
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/05/2008

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