Provider Demographics
NPI:1063097459
Name:DAVIDSON, DEBORAH (LMSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 E LINCOLN AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3536
Mailing Address - Country:US
Mailing Address - Phone:917-435-9184
Mailing Address - Fax:
Practice Address - Street 1:465 E LINCOLN AVE APT 305
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3536
Practice Address - Country:US
Practice Address - Phone:917-435-9184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111398-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker