Provider Demographics
NPI:1033728522
Name:FADER, DEBRA ANN (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:FADER
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1046
Mailing Address - Country:US
Mailing Address - Phone:570-877-0488
Mailing Address - Fax:
Practice Address - Street 1:106 AVENUE C
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1046
Practice Address - Country:US
Practice Address - Phone:570-877-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health