1730193418 NPI number — DEBORAH GORMAN LCSW-R

Table of content: DEBORAH GORMAN LCSW-R (NPI 1730193418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730193418 NPI number — DEBORAH GORMAN LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORMAN
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:
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:
1730193418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3043 STATE ROUTE 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12839-9632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-747-2284
Provider Business Mailing Address Fax Number:
518-747-2253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3043 STATE ROUTE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12839-9632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-747-2284
Provider Business Practice Location Address Fax Number:
518-747-2253
Provider Enumeration Date:
07/28/2006

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:  00061648 , 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: 000409117001 . This is a "EMPIRE BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P01430434 . This is a "MEDICARE RAIL ROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426031840 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000409117001 . This is a "MEDICARE SENIOR BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000409117001 . This is a "BLUE SHIELD OF NORTHEASTERN NEW YORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11623959 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000409117001 . This is a "HEALTHNOW INTEGRATED" identifier . This identifiers is of the category "OTHER".
  • Identifier: NH1731 . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000409117001 . This is a "EMPIRE BC/BS BLUE CARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00069274 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 53088 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




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