Provider Demographics
NPI:1720175748
Name:DRUCKER, DOUGLAS (PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:DRUCKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 S BASCOM AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7317
Mailing Address - Country:US
Mailing Address - Phone:408-377-3510
Mailing Address - Fax:408-377-2941
Practice Address - Street 1:16615 LARK AVE
Practice Address - Street 2:STE 203
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7645
Practice Address - Country:US
Practice Address - Phone:408-358-8792
Practice Address - Fax:408-358-8762
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2012-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14138103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL141380Medicaid
CAOPL141380Medicare ID - Type Unspecified
CAOPL141380Medicaid