Provider Demographics
NPI:1740251479
Name:DEXTER, BEVERLY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:DEXTER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 IBERIA PL STE 135
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2456
Mailing Address - Country:US
Mailing Address - Phone:858-376-7028
Mailing Address - Fax:310-388-4948
Practice Address - Street 1:11650 IBERIA PL STE 135
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2456
Practice Address - Country:US
Practice Address - Phone:858-442-9170
Practice Address - Fax:310-388-4948
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24088103TC0700X
CA24038103TC0700X
MS35-576103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical