Provider Demographics
NPI:1902106263
Name:PRAYER, LINDA MADELEINE (MA)
Entity Type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:MADELEINE
Last Name:PRAYER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 I STREET
Mailing Address - Street 2:#104
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-955-6466
Mailing Address - Fax:
Practice Address - Street 1:2830 I ST
Practice Address - Street 2:# 104
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4311
Practice Address - Country:US
Practice Address - Phone:916-955-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2015-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94021450103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680325078OtherPRIVATE PRACTICE IN CLINICAL PSYCHOLOGY