Provider Demographics
NPI:1316902638
Name:MACHT, DEBRA S (LPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:MACHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 GREAT POND RD
Mailing Address - Street 2:
Mailing Address - City:S GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-3105
Mailing Address - Country:US
Mailing Address - Phone:860-659-2930
Mailing Address - Fax:
Practice Address - Street 1:150 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2003
Practice Address - Country:US
Practice Address - Phone:860-646-1222
Practice Address - Fax:860-647-6829
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000173101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000173OtherLICENSED PRO COUNSELOR