Provider Demographics
NPI:1962940353
Name:DEBORAH L SCHMUCKAL LCSW LLC
Entity type:Organization
Organization Name:DEBORAH L SCHMUCKAL LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHMUCKAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-671-0838
Mailing Address - Street 1:5606 WALSH RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-9723
Mailing Address - Country:US
Mailing Address - Phone:719-671-0838
Mailing Address - Fax:
Practice Address - Street 1:5606 WALSH RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-9723
Practice Address - Country:US
Practice Address - Phone:719-671-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.000007231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty