Provider Demographics
NPI:1710192612
Name:NIELSEN CONROY, DEBORAH BOOTH (MA MFT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:BOOTH
Last Name:NIELSEN CONROY
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:WILHELM
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA MFT
Mailing Address - Street 1:230 SPRECKELS DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-688-5490
Mailing Address - Fax:831-688-7746
Practice Address - Street 1:230 SPRECKELS DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-688-5490
Practice Address - Fax:831-688-7746
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM14170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist