Provider Demographics
NPI:1609949130
Name:PRESTON, DEBORAH G (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:G
Last Name:PRESTON
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 1:2505 SAMARITAN DR STE 603
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4017
Mailing Address - Country:US
Mailing Address - Phone:408-358-1554
Mailing Address - Fax:408-356-8272
Practice Address - Street 1:2450 SAMARITAN DR STE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3912
Practice Address - Country:US
Practice Address - Phone:408-358-1554
Practice Address - Fax:408-356-8272
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6758103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist