Provider Demographics
NPI:1093753808
Name:MORDECAI, DEBRA M (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:MORDECAI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:M
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:46 WEST AVON ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3679
Mailing Address - Country:US
Mailing Address - Phone:860-307-8943
Mailing Address - Fax:860-824-1469
Practice Address - Street 1:46 WEST AVON ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3679
Practice Address - Country:US
Practice Address - Phone:860-307-8943
Practice Address - Fax:860-824-1469
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical