1619987153 NPI number — DEBORAH JO DREYFUSS PHD

Table of content: DEBORAH JO DREYFUSS PHD (NPI 1619987153)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619987153 NPI number — DEBORAH JO DREYFUSS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DREYFUSS
Provider First Name:
DEBORAH
Provider Middle Name:
JO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619987153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23123 VENTURA BLVD
Provider Second Line Business Mailing Address:
STE. 203
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-884-4684
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4766 PARK GRANADA
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
CALABASAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-224-3244
Provider Business Practice Location Address Fax Number:
818-224-3244
Provider Enumeration Date:
08/08/2006

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: 103TC0700X , with the licence number:  PSY12017 , 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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