1497080311 NPI number — LINDA SCHONBERG, PSYCHOLOGIST

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497080311 NPI number — LINDA SCHONBERG, PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA SCHONBERG, PSYCHOLOGIST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497080311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27620 FARMINGTON ROAD
Provider Second Line Business Mailing Address:
SUITE206
Provider Business Mailing Address City Name:
FARMINGTON HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-613-3216
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27620 FARMINGTON RD
Provider Second Line Business Practice Location Address:
SUITE206
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48334-3349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-613-3216
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SCHONBERG
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
248-613-3216

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  6301012746 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6301012746 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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