Provider Demographics
NPI:1275517005
Name:TYSON, DEBORAH K (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:K
Last Name:TYSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:TYSON
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9021 SW 94 STREET
Mailing Address - Street 2:APT 208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2311
Mailing Address - Country:US
Mailing Address - Phone:305-595-8225
Mailing Address - Fax:
Practice Address - Street 1:7700 NORTH KENDALL DRIVE
Practice Address - Street 2:SUITE 413
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7565
Practice Address - Country:US
Practice Address - Phone:305-595-8225
Practice Address - Fax:305-596-6947
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4181103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73459OtherBCBS
FL73459OtherBCBS