Provider Demographics
NPI:1083838122
Name:DARBONNIE, ALLEN ROY (PHD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:ROY
Last Name:DARBONNIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:ALLEN
Other - Middle Name:ROY
Other - Last Name:DARBONNIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2900 SEA RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-2968
Mailing Address - Country:US
Mailing Address - Phone:310-456-7444
Mailing Address - Fax:310-456-7444
Practice Address - Street 1:28990 PACIFIC COAST HWY
Practice Address - Street 2:STE 203
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2968
Practice Address - Country:US
Practice Address - Phone:310-456-7444
Practice Address - Fax:310-456-7444
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP3032Medicare ID - Type Unspecified