Provider Demographics
NPI:1194989053
Name:VON BOLSCHWING, DEBORAH (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:VON BOLSCHWING
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:PO BOX 84
Mailing Address - Street 2:576 OCEANA DRIVE
Mailing Address - City:DILLON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94929
Mailing Address - Country:US
Mailing Address - Phone:707-878-2446
Mailing Address - Fax:
Practice Address - Street 1:576 OCEANA DRIVE
Practice Address - Street 2:
Practice Address - City:DILLON BEACH
Practice Address - State:CA
Practice Address - Zip Code:94929
Practice Address - Country:US
Practice Address - Phone:707-878-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB355039103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist