Provider Demographics
NPI:1699015131
Name:DETMERS, DEANNE MICHELLE (MA)
Entity Type:Individual
Prefix:MS
First Name:DEANNE
Middle Name:MICHELLE
Last Name:DETMERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:DEANNE
Other - Middle Name:MICHELLE
Other - Last Name:DETMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2354 POWELL ST
Mailing Address - Street 2:STE. A
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1738
Mailing Address - Country:US
Mailing Address - Phone:510-652-7445
Mailing Address - Fax:510-652-9288
Practice Address - Street 1:2354 POWELL ST
Practice Address - Street 2:STE. A
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1738
Practice Address - Country:US
Practice Address - Phone:510-652-7445
Practice Address - Fax:510-652-9288
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst