Provider Demographics
NPI:1285832642
Name:KOHLOSS, DEBORAH VAUGHAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:VAUGHAN
Last Name:KOHLOSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2481 CLAY STREET - #203
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:917-940-1642
Mailing Address - Fax:415-227-9997
Practice Address - Street 1:2481 CLAY STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:917-940-1642
Practice Address - Fax:415-227-9997
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15436103TC0700X
CA32775103TC0700X
NY019229-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical