Provider Demographics
NPI:1881728046
Name:RADER, DEVORAH ILENE (PHD)
Entity type:Individual
Prefix:DR
First Name:DEVORAH
Middle Name:ILENE
Last Name:RADER
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 1:17366 W SUNSET BLVD
Mailing Address - Street 2:#101B
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4126
Mailing Address - Country:US
Mailing Address - Phone:310-963-1910
Mailing Address - Fax:310-454-1966
Practice Address - Street 1:17366 W SUNSET BLVD
Practice Address - Street 2:#101B
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-4126
Practice Address - Country:US
Practice Address - Phone:310-963-1910
Practice Address - Fax:310-454-1966
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist