Provider Demographics
NPI:1851173918
Name:HANDOJO, DEBORA BINA (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:BINA
Last Name:HANDOJO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FAIR OAKS BLVD APT 526
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-2709
Mailing Address - Country:US
Mailing Address - Phone:909-446-6967
Mailing Address - Fax:
Practice Address - Street 1:1550 W ROSEDALE ST # 518
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7403
Practice Address - Country:US
Practice Address - Phone:181-734-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical