Provider Demographics
NPI:1811587355
Name:DR. LINDA JOVANOVIC LLC
Entity Type:Organization
Organization Name:DR. LINDA JOVANOVIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:JOVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:530-446-1930
Mailing Address - Street 1:234 CORNWALL AVE
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7117
Mailing Address - Country:US
Mailing Address - Phone:530-446-1930
Mailing Address - Fax:
Practice Address - Street 1:204 W MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4710
Practice Address - Country:US
Practice Address - Phone:530-446-1930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty