Provider Demographics
NPI:1093737033
Name:DUBBERKE, LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:
Last Name:DUBBERKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2419
Mailing Address - Country:US
Mailing Address - Phone:415-751-6766
Mailing Address - Fax:510-235-7814
Practice Address - Street 1:123 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2419
Practice Address - Country:US
Practice Address - Phone:415-751-6766
Practice Address - Fax:510-235-7814
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12303103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL123030Medicare ID - Type Unspecified