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NPI Code Detail

MEDICARE: DR. LINDA G. WATERS PH.D.

MEDICARE: DR. LINDA G. WATERS 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
1103T00000XPsychologistPSY5465CA
2103TC0700XClinical PsychologistPSY5465CA

General Provider Information

NPI Number : 1720081045
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LINDA G. WATERS PH.D.
Provider Business Mailing Address
First Line : 4940 VAN NUYS BLVD.
Second Line : #302
City : SHERMAN OAKS
State : CA
Zip : 91403
Country : US
Telephone Number : 818-990-4497
Fax Number : 818-990-6045
Provider Business Practice Location Address
First Line : 4940 VAN NUYS BL.
Second Line : #302
City : SHERMAN OAKS
State : CA
Zip : 91403
Country : US
Telephone Number : 818-990-4497
Fax Number : 818-990-6045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 01/09/2012

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