Provider Demographics
NPI:1023197092
Name:KOVAS STRETCH, DEBORAH W (MSW LCSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:W
Last Name:KOVAS STRETCH
Suffix:
Gender:F
Credentials:MSW LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CAPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-3468
Mailing Address - Country:US
Mailing Address - Phone:574-252-5376
Mailing Address - Fax:
Practice Address - Street 1:107 N EDDY ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2920
Practice Address - Country:US
Practice Address - Phone:574-246-1036
Practice Address - Fax:574-246-1634
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004169A104100000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN710519000OtherMAGELLAN
IN710519000OtherMAGELLAN