Healthcare Provider Details

I. General information

NPI: 1073641387
Provider Name (Legal Business Name): ANTOINNETTE MONIQUE DEWBERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HAYES ST
SAN FRANCISCO CA
94117-1013
US

IV. Provider business mailing address

1801 BUSH ST STE 114
SAN FRANCISCO CA
94109-5295
US

V. Phone/Fax

Practice location:
  • Phone: 650-219-3713
  • Fax:
Mailing address:
  • Phone: 415-346-2255
  • Fax: 844-946-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: