Provider Demographics
NPI:1497868574
Name:ZILAVY, DEBRA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:ZILAVY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N DUTTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4674
Mailing Address - Country:US
Mailing Address - Phone:707-525-8306
Mailing Address - Fax:707-526-8319
Practice Address - Street 1:1330 N DUTTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4674
Practice Address - Country:US
Practice Address - Phone:707-525-8306
Practice Address - Fax:707-526-8319
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14110103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ57689ZMedicare ID - Type UnspecifiedMEDICARE
CAZ69002Medicare UPIN