Provider Demographics
NPI:1518970375
Name:BANDY, DEBRA DAVIS (MA MFCT)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:DAVIS
Last Name:BANDY
Suffix:
Gender:F
Credentials:MA MFCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12661 HIGHWINDS RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023
Mailing Address - Country:US
Mailing Address - Phone:805-525-1945
Mailing Address - Fax:
Practice Address - Street 1:16161 VENTURA BLVD
Practice Address - Street 2:STE 225
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-990-0699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCT14338103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist