Provider Demographics
NPI:1134200835
Name:EDMOND, DEBORAH L
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:L
Last Name:EDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 S ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4933
Mailing Address - Country:US
Mailing Address - Phone:310-668-5151
Mailing Address - Fax:310-223-0695
Practice Address - Street 1:1662 S ORANGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4933
Practice Address - Country:US
Practice Address - Phone:310-668-5151
Practice Address - Fax:310-223-0695
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health