Provider Demographics
NPI:1356375539
Name:LEFORT, DEBANEY GILL (MFC)
Entity type:Individual
Prefix:MS
First Name:DEBANEY
Middle Name:GILL
Last Name:LEFORT
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 BARCELONA ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6403
Mailing Address - Country:US
Mailing Address - Phone:925-243-9990
Mailing Address - Fax:925-243-9991
Practice Address - Street 1:1763 BARCELONA ST
Practice Address - Street 2:BUILDING B
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6403
Practice Address - Country:US
Practice Address - Phone:925-243-9990
Practice Address - Fax:925-243-9991
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38473106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist