Provider Demographics
NPI:1124225388
Name:DUXBURY, MILDRED (MFT)
Entity Type:Individual
Prefix:MS
First Name:MILDRED
Middle Name:
Last Name:DUXBURY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2407
Mailing Address - Country:US
Mailing Address - Phone:510-601-0203
Mailing Address - Fax:510-601-4002
Practice Address - Street 1:3200 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2407
Practice Address - Country:US
Practice Address - Phone:510-601-0203
Practice Address - Fax:510-601-4002
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20883106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist