Provider Demographics
NPI:1457535098
Name:VON DUERING, REBECCA MARIE (PHD, NCSP, LEP)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:MARIE
Last Name:VON DUERING
Suffix:
Gender:F
Credentials:PHD, NCSP, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PARKER
Mailing Address - Street 2:SUITE C
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1657
Mailing Address - Country:US
Mailing Address - Phone:949-280-0861
Mailing Address - Fax:949-855-0134
Practice Address - Street 1:45 PARKER
Practice Address - Street 2:SUITE C
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1657
Practice Address - Country:US
Practice Address - Phone:949-280-0861
Practice Address - Fax:949-855-0134
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP 2925101YS0200X, 103T00000X, 103TB0200X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities