Basic Information
| Provider Information | |||||||||
| NPI: | 1265870414 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERSHTMAN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | S.PSY.S, L.L.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2790 PARKWICK CT | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483244105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483632850 | ||||||||
| FaxNumber: | 8003806809 | ||||||||
| Practice Location | |||||||||
| Address1: | 8898 COMMERCE RD | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | COMMERCE TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483824485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483632850 | ||||||||
| FaxNumber: | 8003806809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2013 | ||||||||
| LastUpdateDate: | 06/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | 6301012935 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No ID Information.