Provider Demographics
NPI:1114959624
Name:VAUGHAN, DEBORAH M (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 STONE HORSE RD
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1701
Mailing Address - Country:US
Mailing Address - Phone:508-428-2372
Mailing Address - Fax:
Practice Address - Street 1:12 STONE HORSE RD
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1701
Practice Address - Country:US
Practice Address - Phone:508-428-2372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1112671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA451337OtherTUFTS HEALTHPLAN
MAP08462OtherBCBS PPO
MA451337OtherTUFTS HEALTHPLAN