Provider Demographics
NPI:1992880975
Name:CIRCO, DEBORAH K (IMHP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:CIRCO
Suffix:
Gender:F
Credentials:IMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MED CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-559-8943
Mailing Address - Fax:
Practice Address - Street 1:985450 NEBRASKA MED CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5450
Practice Address - Country:US
Practice Address - Phone:402-559-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025287200Medicaid
NES58097Medicare UPIN
NE270745REMedicare ID - Type Unspecified