Provider Demographics
NPI:1801942438
Name:MAYERS, LINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:MAYERS
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 1:127 W 96TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6427
Mailing Address - Country:US
Mailing Address - Phone:212-865-4212
Mailing Address - Fax:212-932-0919
Practice Address - Street 1:127 W 96TH ST
Practice Address - Street 2:12J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6427
Practice Address - Country:US
Practice Address - Phone:212-865-4212
Practice Address - Fax:212-932-0919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005401103TC0700X, 103TP0814X, 103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146910OtherVALUE OPTIONS ID #
NY0098443OtherGHI ID #