Provider Demographics
NPI:1962548701
Name:DURITZ, LINDA FELDMAN
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:FELDMAN
Last Name:DURITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2424
Mailing Address - Country:US
Mailing Address - Phone:510-664-9357
Mailing Address - Fax:
Practice Address - Street 1:36 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2424
Practice Address - Country:US
Practice Address - Phone:510-664-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG712702084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF19766Medicare UPIN