MEDICARE: LINDA M ERCOLI 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	2084P0805X	Geriatric Psychiatry Physician	PSY15935	CA
2	103TC0700X	Clinical Psychologist	PSY15935	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821104522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA M ERCOLI PH.D

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-825-9989
Fax Number	:

Provider Business Practice Location Address
First Line	:	760 WESTWOOD PLZ STE 38-239
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5055
Country	:	US
Telephone Number	:	310-825-9208
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/16/2024

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Directions to “ LINDA M ERCOLI PH.D” Practice Location

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