Provider Demographics
NPI:1568777100
Name:NELSON, DEBORAH KAY (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1515
Mailing Address - Country:US
Mailing Address - Phone:415-686-8936
Mailing Address - Fax:
Practice Address - Street 1:2400 LAS GALLINAS AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1447
Practice Address - Country:US
Practice Address - Phone:415-578-0232
Practice Address - Fax:415-532-1515
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health