1215389432 NPI number — DEBORAH KOEPPEL LCSW-R

Table of content: DEBORAH KOEPPEL LCSW-R (NPI 1215389432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215389432 NPI number — DEBORAH KOEPPEL LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOEPPEL
Provider First Name:
DEBORAH
Provider Middle Name:
Provider Name Prefix Text:
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:
WALTZER-KOEPPEL
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-R
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215389432
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 EAST 34TH STREET - NYU PERLMUTTER CANCER CENTER
Provider Second Line Business Mailing Address:
SUITE 1105
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-9994
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-731-5108
Provider Business Mailing Address Fax Number:
121-273-1564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
160 EAST 34TH STREET - DEBORAH KOEPPEL
Provider Second Line Business Practice Location Address:
ROOM 1105
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-9994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-731-5108
Provider Business Practice Location Address Fax Number:
121-273-1564
Provider Enumeration Date:
07/12/2016

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:  R049565-1 , 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: R049565-1 . This is a "SOCIAL WORK LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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