Provider Demographics
NPI:1114007945
Name:ECKERT, DEBORAH ANN (LISW, LICDC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:ECKERT
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8980 WHISPERINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4667
Mailing Address - Country:US
Mailing Address - Phone:513-678-0510
Mailing Address - Fax:
Practice Address - Street 1:9122 MONTGOMERY RD
Practice Address - Street 2:SUITE 12
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7745
Practice Address - Country:US
Practice Address - Phone:513-678-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH912955101YA0400X
OHI96931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW26572Medicare PIN