Provider Demographics
NPI:1740454321
Name:WISS, DEBORAH EILEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:EILEEN
Last Name:WISS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10444 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6959
Mailing Address - Country:US
Mailing Address - Phone:310-824-2155
Mailing Address - Fax:310-470-7969
Practice Address - Street 1:10444 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6959
Practice Address - Country:US
Practice Address - Phone:310-824-2155
Practice Address - Fax:310-470-7969
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical