Provider Demographics
NPI:1083736250
Name:EBERTH, LINDA DIANE (PHD CLINICAL PSYCHOL)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:DIANE
Last Name:EBERTH
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Gender:F
Credentials:PHD CLINICAL PSYCHOL
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Mailing Address - Street 1:12301 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-314-1858
Mailing Address - Fax:310-314-1848
Practice Address - Street 1:12301 WILSHIRE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-314-1858
Practice Address - Fax:310-314-1848
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY13672103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL136720OtherBLUE SHIELD
CAOPL136721OtherBLUE SHIELD