Provider Demographics
NPI:1396054268
Name:STERN, DEBORAH (MA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:STERN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 WALLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-1710
Mailing Address - Country:US
Mailing Address - Phone:410-961-4894
Mailing Address - Fax:
Practice Address - Street 1:7023 WALLIS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1710
Practice Address - Country:US
Practice Address - Phone:410-961-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3333101YP2500X
MDLC4723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional