Provider Demographics
NPI:1346438611
Name:DEBORA VANDERVEER
Entity type:Organization
Organization Name:DEBORA VANDERVEER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC PLUS SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBRCKIY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-253-9795
Mailing Address - Street 1:8816 WANDERING WAY
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1513
Mailing Address - Country:US
Mailing Address - Phone:315-253-4316
Mailing Address - Fax:315-253-3255
Practice Address - Street 1:17 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4040
Practice Address - Country:US
Practice Address - Phone:315-253-4316
Practice Address - Fax:315-253-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare