Provider Demographics
NPI:1619063385
Name:HENDLIN, DEBORAH ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELLEN
Last Name:HENDLIN
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 1:230 NEWPORT CENTER DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-644-7707
Mailing Address - Fax:
Practice Address - Street 1:230 NEWPORT CENTER DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-644-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11452103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical