Provider Demographics
NPI:1174704290
Name:NELSON, DEBORAH RIVA (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:RIVA
Last Name:NELSON
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:DR
Other - First Name:RIVA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MFT
Mailing Address - Street 1:100 TAMAL PLZ
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1125
Mailing Address - Country:US
Mailing Address - Phone:415-455-4880
Mailing Address - Fax:415-927-3660
Practice Address - Street 1:100 TAMAL PLZ
Practice Address - Street 2:SUITE 107
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1125
Practice Address - Country:US
Practice Address - Phone:415-455-4880
Practice Address - Fax:415-927-3660
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 14164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist