Provider Demographics
NPI:1124630488
Name:KIRSTEN, DEBORAH LEE
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LEE
Last Name:KIRSTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LEE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:123 NARRAGANSETT BAY AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-6611
Mailing Address - Country:US
Mailing Address - Phone:928-607-5415
Mailing Address - Fax:
Practice Address - Street 1:2 REGENCY PLZ STE 3
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-3149
Practice Address - Country:US
Practice Address - Phone:401-383-8198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist