Provider Demographics
NPI:1417080136
Name:REED, LYNDA C (PHD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:C
Last Name:REED
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 1:1035 SAN PABLO AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2277
Mailing Address - Country:US
Mailing Address - Phone:510-932-1750
Mailing Address - Fax:888-706-4141
Practice Address - Street 1:1035 SAN PABLO AVE STE 8
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2277
Practice Address - Country:US
Practice Address - Phone:510-932-1750
Practice Address - Fax:949-757-2541
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12415103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P40398Medicare UPIN
CA0PL124152Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST
CA0PL124152Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST