1164745212 NPI number — MRS. DEBORAH LEE LOCICERO LCSW-R

Table of content: MRS. DEBORAH LEE LOCICERO LCSW-R (NPI 1164745212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164745212 NPI number — MRS. DEBORAH LEE LOCICERO LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCICERO
Provider First Name:
DEBORAH
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DESTEFANO
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-R
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164745212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2345 ROUTE 52
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
HOPEWELL JUNCTION
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12533-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-815-7271
Provider Business Mailing Address Fax Number:
888-972-5017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 ROUTE 52
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
HOPEWELL JUNCTION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12533-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-815-7271
Provider Business Practice Location Address Fax Number:
888-972-5017
Provider Enumeration Date:
03/03/2010

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: 1041C0700X , with the licence number:  R027894-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6612266 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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