Provider Demographics
NPI:1467584037
Name:AVERY, LINDA CUDDY (PHD)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:CUDDY
Last Name:AVERY
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 1:2447 SANTA CLARA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4575
Mailing Address - Country:US
Mailing Address - Phone:510-769-9008
Mailing Address - Fax:510-769-1409
Practice Address - Street 1:2447 SANTA CLARA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4575
Practice Address - Country:US
Practice Address - Phone:510-769-9008
Practice Address - Fax:510-769-1409
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PL169400Medicare ID - Type Unspecified