Individual provider Active NPI

Linda Lucille Guerra, PH.D.

  • Clinical Psychologist
  • Philadelphia, PA
National Provider Identifier
1669548459
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS004679L Issued in PA
Practice address
255 S 17TH St
Suite 1909
Philadelphia, PA 19103-6231
Phone
(215) 545-7009
Fax
(610) 571-1403
NPI assigned
Nov 26, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS004679L PA Primary

Addresses

Primary practice location

255 S 17TH St
Suite 1909
Philadelphia, PA 19103-6231

Mailing address

255 S 17TH St
Suite 1909
Philadelphia, PA 19103-6231
Phone (215) 545-7009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071208000007 PA Practitioner - Clinical Psychologist 3971692377 Practice locations: Bala Cynwyd, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1 Bala Ave
Suite 110
Bala Cynwyd, PA 19004-3207
Phone (215) 545-7009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669548459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 S 17TH ST",
            "address_2": "SUITE 1909",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191036231",
            "telephone_number": "215-545-7009",
            "fax_number": "610-571-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 S 17TH ST",
            "address_2": "SUITE 1909",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191036231",
            "telephone_number": "215-545-7009",
            "fax_number": "610-571-1403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUERRA",
        "first_name": "LINDA",
        "middle_name": "LUCILLE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS004679L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.