Provider Demographics
NPI:1043572605
Name:WILLIS, DEBORAH (LISWS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LISWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 SUPERIOR AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2101
Mailing Address - Country:US
Mailing Address - Phone:216-391-4970
Mailing Address - Fax:216-664-0582
Practice Address - Street 1:2125 SUPERIOR AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2101
Practice Address - Country:US
Practice Address - Phone:216-391-4970
Practice Address - Fax:216-664-0582
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00030381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical