Provider Demographics
NPI:1962470179
Name:BORSON, LINDA SIMONE (MED)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SIMONE
Last Name:BORSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3309
Mailing Address - Country:US
Mailing Address - Phone:610-356-0462
Mailing Address - Fax:610-595-6273
Practice Address - Street 1:101 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3309
Practice Address - Country:US
Practice Address - Phone:610-356-0462
Practice Address - Fax:610-595-6273
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004143-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA148287Medicare ID - Type UnspecifiedMEDICARE
R06329Medicare UPIN