Provider Demographics
NPI:1366451254
Name:BRUBAKER, DOREEN MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:MARIE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DOREEN
Other - Middle Name:MARIE
Other - Last Name:BRUBAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3410 BEECH POINT DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1313
Mailing Address - Country:US
Mailing Address - Phone:281-488-5388
Mailing Address - Fax:800-819-1655
Practice Address - Street 1:3410 BEECH POINT DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-1313
Practice Address - Country:US
Practice Address - Phone:281-488-5388
Practice Address - Fax:800-819-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123942805Medicaid
TX00U14FMedicare ID - Type Unspecified