Provider Demographics
NPI:1346311792
Name:RICHARDSON, LINDA MAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MAE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 KENNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1846
Mailing Address - Country:US
Mailing Address - Phone:818-243-4543
Mailing Address - Fax:
Practice Address - Street 1:7285 QUILL DR
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2001
Practice Address - Country:US
Practice Address - Phone:562-940-8767
Practice Address - Fax:562-803-0637
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical