Provider Demographics
NPI:1649606187
Name:LINDER, JASON NEAL (MA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:NEAL
Last Name:LINDER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 CANYON ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930
Mailing Address - Country:US
Mailing Address - Phone:415-939-4861
Mailing Address - Fax:
Practice Address - Street 1:189 CANYON ROAD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930
Practice Address - Country:US
Practice Address - Phone:415-939-4861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76134106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist