Provider Demographics
NPI:1659460517
Name:DUECK, AL C (PHD,)
Entity type:Individual
Prefix:DR
First Name:AL
Middle Name:C
Last Name:DUECK
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FULLER GRADUATE SCHOOL OF PSYCHOLOGY
Mailing Address - Street 2:180 N. OAKLAND
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-584-5537
Mailing Address - Fax:626-584-9630
Practice Address - Street 1:FULLER GRADUATE SCHOOL OF PSYCHOLOGY
Practice Address - Street 2:180 N. OAKLAND
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-584-5537
Practice Address - Fax:626-584-9630
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11716103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist