Provider Demographics
NPI:1295707305
Name:PETTI, LINDA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:PETTI
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 1:1250 GREENWOOD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2901
Mailing Address - Country:US
Mailing Address - Phone:215-885-2990
Mailing Address - Fax:215-885-2366
Practice Address - Street 1:1250 GREENWOOD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-2901
Practice Address - Country:US
Practice Address - Phone:215-885-2990
Practice Address - Fax:215-885-2366
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003471L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA031066OtherBLUE SHIELD
PA031066OtherBLUE SHIELD