Provider Demographics
NPI:1811061260
Name:APPLEBAUM, DEBRA R (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:APPLEBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MONROE PKWY
Mailing Address - Street 2:STE 280
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8867
Mailing Address - Country:US
Mailing Address - Phone:503-635-8710
Mailing Address - Fax:503-635-0583
Practice Address - Street 1:9 MONROE PKWY
Practice Address - Street 2:STE 280
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8867
Practice Address - Country:US
Practice Address - Phone:503-635-8710
Practice Address - Fax:503-635-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROOOOTCMBPMedicare ID - Type Unspecified