Provider Demographics
NPI:1609978931
Name:DIFERDINANDO, DEBORAH (PSYD, MFT, CADCII)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:DIFERDINANDO
Suffix:
Gender:F
Credentials:PSYD, MFT, CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611A S. MELROSE DR.
Mailing Address - Street 2:#301
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081
Mailing Address - Country:US
Mailing Address - Phone:760-822-4877
Mailing Address - Fax:760-842-1313
Practice Address - Street 1:2564 STATE ST
Practice Address - Street 2:STE B
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1662
Practice Address - Country:US
Practice Address - Phone:760-822-4877
Practice Address - Fax:760-842-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22608103TC0700X
CAMFC37170106H00000X
CAA8381801101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)