Provider Demographics
NPI:1578631610
Name:DUVERGER, RENEE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:A
Last Name:DUVERGER
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 1:3434 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1812
Mailing Address - Country:US
Mailing Address - Phone:619-281-3706
Mailing Address - Fax:619-281-3714
Practice Address - Street 1:3434 GROVE ST
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1812
Practice Address - Country:US
Practice Address - Phone:619-281-3706
Practice Address - Fax:619-281-3714
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program