Provider Demographics
NPI:1669429767
Name:MATHER, DEBORAH GWEN (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:GWEN
Last Name:MATHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16033 BOLSA CHICA ST
Mailing Address - Street 2:SUITE #104-239
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2452
Mailing Address - Country:US
Mailing Address - Phone:714-846-8230
Mailing Address - Fax:714-840-6508
Practice Address - Street 1:6615 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE #115
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4211
Practice Address - Country:US
Practice Address - Phone:562-596-0090
Practice Address - Fax:562-596-0094
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY17113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP17113CMedicare ID - Type Unspecified
CAP26304Medicare UPIN
CAWCP17113DMedicare ID - Type Unspecified