Healthcare Provider Details

I. General information

NPI: 1740251479
Provider Name (Legal Business Name): BEVERLY ANN DEXTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14233 COEUR D ALENE CT
VALLEY CENTER CA
92082-6668
US

IV. Provider business mailing address

14233 COEUR D ALENE CT
VALLEY CENTER CA
92082-6668
US

V. Phone/Fax

Practice location:
  • Phone: 858-442-9170
  • Fax:
Mailing address:
  • Phone: 858-442-9170
  • Fax: 619-209-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35-576
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 24088
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: