Provider Demographics
NPI:1215014576
Name:JOCKIN, DEBORAH ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:JOCKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:HUDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8400 W HARRISON CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1905
Mailing Address - Country:US
Mailing Address - Phone:540-786-3978
Mailing Address - Fax:540-310-0791
Practice Address - Street 1:312 PROGRESS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3356
Practice Address - Country:US
Practice Address - Phone:540-310-0797
Practice Address - Fax:540-310-0791
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904-0044811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA130640OtherVALUE OPTIONS
VA209123OtherCAREFIRST
VA8922390Medicaid
VA209122OtherANTHEM
VA5394030OtherAETNA
VA130640OtherVALUE OPTIONS