Provider Demographics
NPI:1114040458
Name:BRUNSON, LINDA KAY (PHD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:BRUNSON
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 1:5435 COLLEGE AVENUE
Mailing Address - Street 2:SUITE 202-7
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618
Mailing Address - Country:US
Mailing Address - Phone:510-652-7702
Mailing Address - Fax:925-979-1460
Practice Address - Street 1:5435 COLLEGE AVENUE
Practice Address - Street 2:SUITE 202-7
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618
Practice Address - Country:US
Practice Address - Phone:510-652-7702
Practice Address - Fax:925-979-1460
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2011-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14086103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical