Provider Demographics
NPI:1851837298
Name:DERAGON, DEBRA TUCKER (LICSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:TUCKER
Last Name:DERAGON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BLACKSMITH RD
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-1934
Mailing Address - Country:US
Mailing Address - Phone:401-419-6175
Mailing Address - Fax:401-289-0006
Practice Address - Street 1:60 BAY SPRING AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:BARRINGTON
Practice Address - State:RI
Practice Address - Zip Code:02806-1384
Practice Address - Country:US
Practice Address - Phone:617-866-0589
Practice Address - Fax:508-557-0234
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-09
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW023061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical