Provider Demographics
NPI:1902682396
Name:MIDDLEBROOK, DEJA LA SHAY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DEJA
Middle Name:LA SHAY
Last Name:MIDDLEBROOK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W GENESEE ST # 1116
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2604
Mailing Address - Country:US
Mailing Address - Phone:716-239-4746
Mailing Address - Fax:
Practice Address - Street 1:695 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3162
Practice Address - Country:US
Practice Address - Phone:716-710-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116560-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker