Healthcare Provider Details

I. General information

NPI: 1053003590
Provider Name (Legal Business Name): EVA DUBOFF LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 EVERGREEN AVE
MILL VALLEY CA
94941-3317
US

IV. Provider business mailing address

137 EVERGREEN AVE
MILL VALLEY CA
94941-3317
US

V. Phone/Fax

Practice location:
  • Phone: 415-420-4525
  • Fax:
Mailing address:
  • Phone: 415-420-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225327
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC22000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: