Provider Demographics
NPI:1932287521
Name:BURGARD, DEBORA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:LYNN
Last Name:BURGARD
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 1:5050 EL CAMINO REAL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1530
Mailing Address - Country:US
Mailing Address - Phone:650-321-2606
Mailing Address - Fax:
Practice Address - Street 1:5050 EL CAMINO REAL
Practice Address - Street 2:SUITE 202
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1530
Practice Address - Country:US
Practice Address - Phone:650-321-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13415103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist