Provider Demographics
NPI:1396758876
Name:OCALLAGHAN, DEBORAH ANN (LISW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:OCALLAGHAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5044
Mailing Address - Country:US
Mailing Address - Phone:505-639-2834
Mailing Address - Fax:
Practice Address - Street 1:1135 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2946
Practice Address - Country:US
Practice Address - Phone:505-525-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-3445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100712OtherVALUE OPTIONS
NM00703265Medicaid