Provider Demographics
NPI:1497080311
Name:LINDA SCHONBERG, PSYCHOLOGIST
Entity Type:Organization
Organization Name:LINDA SCHONBERG, PSYCHOLOGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SCHONBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD,LP
Authorized Official - Phone:248-613-3216
Mailing Address - Street 1:27620 FARMINGTON ROAD
Mailing Address - Street 2:SUITE206
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-613-3216
Mailing Address - Fax:
Practice Address - Street 1:27620 FARMINGTON RD
Practice Address - Street 2:SUITE206
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3349
Practice Address - Country:US
Practice Address - Phone:248-613-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012746302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301012746Medicaid