Provider Demographics
NPI:1992138929
Name:KORY, DEBORAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:KORY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 BERKELEY WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1007
Mailing Address - Country:US
Mailing Address - Phone:510-402-5221
Mailing Address - Fax:
Practice Address - Street 1:1905 BERKELEY WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1007
Practice Address - Country:US
Practice Address - Phone:510-402-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25717103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist