Provider Demographics
NPI:1740408806
Name:BLACKBURN, DEBORAH L (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:L
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 LEIMERT BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1808
Mailing Address - Country:US
Mailing Address - Phone:510-482-8300
Mailing Address - Fax:510-482-7471
Practice Address - Street 1:1425 LEIMERT BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1808
Practice Address - Country:US
Practice Address - Phone:510-482-8300
Practice Address - Fax:510-482-7471
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist