| Doctor Name: | DR. LINDA DIANE EBERTH |
| NPI Number: | 1083736250 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD CLINICAL PSYCHOL |
| License Number: | PSY13672 |
| Business Practice Address: | 12301 Wilshire Blvd Suite 210 West Los Angeles, CA - 90025 |
| Business Phone Number: | 3103141858 |
| Business Fax Number: | 3103141848 |
| Mailing Address: | 12301 Wilshire Blvd, Suite 210 WEST LOS ANGELES |
| State: | CA |
| Postal Code: | 90025 |
| Phone Number: | 3103141858 |
| Fax Number: | 3103141848 |
| NPI Enumeration Date: | 04/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY13672 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |