Provider Demographics
NPI:1336169978
Name:HALLER, DEBORAH (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HALLER
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 1:321 DYER ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-1737
Mailing Address - Country:US
Mailing Address - Phone:804-502-9925
Mailing Address - Fax:804-502-9925
Practice Address - Street 1:321 DYER RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-1219
Practice Address - Country:US
Practice Address - Phone:804-502-9925
Practice Address - Fax:804-502-9925
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015827-1103T00000X
FLPY9146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02532956Medicaid
NYVM4481Medicare ID - Type UnspecifiedMEDICARE