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NPI Code Detail

MEDICARE: DR. LINDA MARLENE POVERNY PH.D.

MEDICARE:  DR. LINDA MARLENE POVERNY  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
1101YA0400XAddiction (Substance Use Disorder) CounselorLL9543CA
2101YM0800XMental Health CounselorLL9543CA
31041C0700XClinical Social WorkerLL9543CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LL9543OTHERCALICENSE

General Provider Information

NPI Number : 1699791202
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LINDA MARLENE POVERNY PH.D.
Provider Business Mailing Address
First Line : 3215 ETTRICK ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-2503
Country : US
Telephone Number : 323-661-0403
Fax Number : 323-667-1253
Provider Business Practice Location Address
First Line : 2001 S BARRINGTON AVE
Second Line : SUITE 222
City : LOS ANGELES
State : CA
Zip : 90025-5363
Country : US
Telephone Number : 323-661-0403
Fax Number : 323-667-1253
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 09/11/2025

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Directions to “ DR. LINDA MARLENE POVERNY PH.D.” Practice Location

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