1316191257 NPI number — DEBRA BETH FUTTERMAN LCSW

Table of content: DEBRA BETH FUTTERMAN LCSW (NPI 1316191257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316191257 NPI number — DEBRA BETH FUTTERMAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FUTTERMAN
Provider First Name:
DEBRA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316191257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1021 NW 53RD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064-8642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-298-0979
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7390 NW 5TH ST
Provider Second Line Business Practice Location Address:
UNIT #5
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-583-8831
Provider Business Practice Location Address Fax Number:
954-583-9575
Provider Enumeration Date:
11/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  SW6829 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 766412500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 761266400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".