Provider Demographics
NPI:1437259710
Name:ULRICH, LINDA ANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANNE
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-4327
Mailing Address - Country:US
Mailing Address - Phone:215-657-4815
Mailing Address - Fax:215-332-1914
Practice Address - Street 1:8001 ROOSEVELT BLVD
Practice Address - Street 2:205-207
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-332-1914
Practice Address - Fax:215-332-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007190L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0873626000OtherMAGELLAN ID
PA5790198OtherAETNA ID