Provider Demographics
NPI:1528190006
Name:PODD, LINDA S (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:PODD
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 1:672 ASPEN LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2164
Mailing Address - Country:US
Mailing Address - Phone:203-530-7853
Mailing Address - Fax:
Practice Address - Street 1:672 ASPEN LN
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-2164
Practice Address - Country:US
Practice Address - Phone:203-530-7853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680000201Medicare ID - Type Unspecified