Provider Demographics
NPI:1033208996
Name:HANNA, DEBORAH D (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D
Last Name:HANNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-0721
Mailing Address - Country:US
Mailing Address - Phone:904-273-6747
Mailing Address - Fax:904-273-6861
Practice Address - Street 1:100 EXECUTIVE WAY
Practice Address - Street 2:SUITE 113
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-273-6747
Practice Address - Fax:904-273-6861
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121221900216OtherCCN
FLR60215Medicare UPIN
FLZ6304Medicare ID - Type Unspecified