MEDICARE: DEBORAH KAY NELSON PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1568777100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH KAY NELSON PSY.D.

Provider Business Mailing Address
First Line	:	37 SPRUCE RD
Second Line	:
City	:	FAIRFAX
State	:	CA
Zip	:	94930-1515
Country	:	US
Telephone Number	:	415-686-8936
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 LAS GALLINAS AVE
Second Line	:	SUITE 155
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-1447
Country	:	US
Telephone Number	:	415-578-0232
Fax Number	:	415-532-1515

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2010
Last Update Date	:	08/17/2015

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