Provider Demographics
NPI:1528134491
Name:LEBEAUX, DEBORAH J (LCSWR)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:J
Last Name:LEBEAUX
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8091 BAPTIST HILL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9724
Mailing Address - Country:US
Mailing Address - Phone:585-657-5315
Mailing Address - Fax:
Practice Address - Street 1:100 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3303
Practice Address - Country:US
Practice Address - Phone:585-461-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0377521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7233458OtherAETNA
NY11531BMedicare ID - Type Unspecified