Provider Demographics
NPI:1336385327
Name:HALLIDAY, DEBRA M (PSYD, CGP)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:PSYD, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5152
Mailing Address - Country:US
Mailing Address - Phone:760-635-3310
Mailing Address - Fax:760-452-7525
Practice Address - Street 1:355 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5152
Practice Address - Country:US
Practice Address - Phone:760-635-3310
Practice Address - Fax:760-452-7525
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL232060OtherBLUE SHIELD PIN
CAOPL232060OtherBLUE SHIELD PIN