Provider Demographics
NPI:1093787681
Name:ANDERSON, DEBORAH ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELAINE
Last Name:ANDERSON
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 1:15233 VENTURA BLVD
Mailing Address - Street 2:SUITE 1202
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2201
Mailing Address - Country:US
Mailing Address - Phone:818-235-2158
Mailing Address - Fax:818-981-3634
Practice Address - Street 1:15233 VENTURA BLVD
Practice Address - Street 2:SUITE 1202
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2201
Practice Address - Country:US
Practice Address - Phone:818-235-2158
Practice Address - Fax:818-981-3634
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16034103G00000X, 103T00000X, 103TF0200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16034Medicare ID - Type Unspecified