Provider Demographics
NPI:1194855395
Name:DEARBORN, ALAN STUART (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:STUART
Last Name:DEARBORN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 EL CAMINO REAL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94027-4127
Mailing Address - Country:US
Mailing Address - Phone:415-933-9427
Mailing Address - Fax:650-325-2019
Practice Address - Street 1:1706 EL CAMINO REAL
Practice Address - Street 2:SUITE 101
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94027-4127
Practice Address - Country:US
Practice Address - Phone:415-933-9427
Practice Address - Fax:650-325-2019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY25011103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY25011OtherCALIFORNIA BOARD OF PSYCHOLOGY