Healthcare Provider Details

I. General information

NPI: 1467092155
Provider Name (Legal Business Name): DEBORAH MARIA WARD PHD, LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LONG BEACH BLVD STE 303
LONG BEACH CA
90807-3354
US

IV. Provider business mailing address

154 CLAREMONT AVE
LONG BEACH CA
90803-3456
US

V. Phone/Fax

Practice location:
  • Phone: 626-808-4013
  • Fax:
Mailing address:
  • Phone: 562-355-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number3411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: