Provider Demographics
NPI:1104910058
Name:NOZIK, DEBRA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:M
Last Name:NOZIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-4414
Mailing Address - Country:US
Mailing Address - Phone:518-464-4440
Mailing Address - Fax:518-464-4471
Practice Address - Street 1:1740 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-4414
Practice Address - Country:US
Practice Address - Phone:518-464-4440
Practice Address - Fax:518-464-4471
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR026816-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50498PMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER