Provider Demographics
NPI:1083199145
Name:DEJEAN, DEBORAH MICHELLE (LMHC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MICHELLE
Last Name:DEJEAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:365 CLINTON AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1151
Mailing Address - Country:US
Mailing Address - Phone:347-731-4734
Mailing Address - Fax:
Practice Address - Street 1:240 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5841
Practice Address - Country:US
Practice Address - Phone:347-731-4734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health