Provider Demographics
NPI:1912668542
Name:LINETZKY, KERRY E (MFT/ATR-BC)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:E
Last Name:LINETZKY
Suffix:
Gender:F
Credentials:MFT/ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1640
Mailing Address - Country:US
Mailing Address - Phone:510-906-1803
Mailing Address - Fax:
Practice Address - Street 1:5735 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1640
Practice Address - Country:US
Practice Address - Phone:510-906-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT42032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical