Provider Demographics
NPI:1467658757
Name:VANDERGRIEND, DEBRA ANN
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:VANDERGRIEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:VANDERGRIEND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:641 5TH ST W APT 5
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6832
Mailing Address - Country:US
Mailing Address - Phone:707-334-2877
Mailing Address - Fax:
Practice Address - Street 1:914 MISSION AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-6106
Practice Address - Country:US
Practice Address - Phone:415-457-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA154761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical