Provider Demographics
NPI:1154428241
Name:BUCKWALTER, DEBORAH K (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:K
Last Name:BUCKWALTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 N MARENGO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1764
Mailing Address - Country:US
Mailing Address - Phone:626-644-1454
Mailing Address - Fax:626-355-2583
Practice Address - Street 1:95 N MARENGO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1764
Practice Address - Country:US
Practice Address - Phone:626-644-1454
Practice Address - Fax:626-355-2583
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17676103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP17676AMedicare ID - Type UnspecifiedPSYCHOLOGIST