Provider Demographics
NPI:1487790275
Name:MININGER, LINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:MININGER
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 1:1447 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2805
Mailing Address - Country:US
Mailing Address - Phone:707-252-6886
Mailing Address - Fax:707-255-0109
Practice Address - Street 1:1447 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2805
Practice Address - Country:US
Practice Address - Phone:707-252-6886
Practice Address - Fax:707-255-0109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 4626103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOPL4626OMedicare PIN