Provider Demographics
NPI:1477697001
Name:LONGSERRE, LINDA L (LMFT, LPCC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:LONGSERRE
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FREMONT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3225
Mailing Address - Country:US
Mailing Address - Phone:626-319-0705
Mailing Address - Fax:
Practice Address - Street 1:1000 FREMONT AVE STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3225
Practice Address - Country:US
Practice Address - Phone:626-319-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43138106H00000X
CALPC132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health