Provider Demographics
NPI:1942463047
Name:PURYEAR, DEBRA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:PURYEAR
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 1:1242 PARK ST STE C
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5500
Mailing Address - Country:US
Mailing Address - Phone:510-521-3500
Mailing Address - Fax:510-521-8253
Practice Address - Street 1:1242 PARK ST STE C
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5500
Practice Address - Country:US
Practice Address - Phone:510-521-3500
Practice Address - Fax:510-521-8253
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL90020Medicare UPIN