MEDICARE: DR. LINDA DIANE CROOKS 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	PSY11147	CA

General Provider Information

NPI Number	:	1801998596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA DIANE CROOKS PH.D.

Provider Business Mailing Address
First Line	:	2444 WILSHIRE BLVD
Second Line	:	607
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5808
Country	:	US
Telephone Number	:	310-828-7450
Fax Number	:	310-399-5503

Provider Business Practice Location Address
First Line	:	2444 WILSHIRE BLVD
Second Line	:	607
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5808
Country	:	US
Telephone Number	:	310-828-7450
Fax Number	:	310-399-5503

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	07/08/2007

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