Provider Demographics
NPI:1114128246
Name:DEBAUN, ANDY (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:DEBAUN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 W 76TH ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-1518
Mailing Address - Country:US
Mailing Address - Phone:914-400-3160
Mailing Address - Fax:
Practice Address - Street 1:207 WARREN ST
Practice Address - Street 2:# 3
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4411
Practice Address - Country:US
Practice Address - Phone:914-400-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0694481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical