Provider Demographics
NPI:1619987153
Name:DREYFUSS, DEBORAH JO (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JO
Last Name:DREYFUSS
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 1:23123 VENTURA BLVD
Mailing Address - Street 2:STE. 203
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1104
Mailing Address - Country:US
Mailing Address - Phone:818-884-4684
Mailing Address - Fax:
Practice Address - Street 1:4766 PARK GRANADA
Practice Address - Street 2:SUITE 107
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302
Practice Address - Country:US
Practice Address - Phone:818-224-3244
Practice Address - Fax:818-224-3244
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12017103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R15673Medicare UPIN
CACP12017Medicare ID - Type Unspecified