Provider Demographics
NPI:1124090261
Name:ROSSIGNOL, DEBORAH M (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:ROSSIGNOL
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 LAKE FOREST PASS
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-2513
Mailing Address - Country:US
Mailing Address - Phone:678-585-0155
Mailing Address - Fax:678-585-0155
Practice Address - Street 1:760 LAKE FOREST PASS
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2513
Practice Address - Country:US
Practice Address - Phone:678-585-0155
Practice Address - Fax:678-585-0155
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0035381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPO MM5458Medicare ID - Type Unspecified
ME7483226Medicare UPIN
ME038927Medicare UPIN