1710192612 NPI number — MRS. DEBORAH BOOTH NIELSEN CONROY MA MFT

Table of content: MRS. DEBORAH BOOTH NIELSEN CONROY MA MFT (NPI 1710192612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710192612 NPI number — MRS. DEBORAH BOOTH NIELSEN CONROY MA MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIELSEN CONROY
Provider First Name:
DEBORAH
Provider Middle Name:
BOOTH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NIELSEN
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
WILHELM
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA MFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1710192612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 SPRECKELS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-688-5490
Provider Business Mailing Address Fax Number:
831-688-7746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 SPRECKELS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-688-5490
Provider Business Practice Location Address Fax Number:
831-688-7746
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  M14170 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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