Provider Demographics
NPI:1164817300
Name:JOSSELYN, DEBORAH L
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:JOSSELYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JOSSELYN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3601 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85723-0001
Mailing Address - Country:US
Mailing Address - Phone:520-792-1450
Mailing Address - Fax:520-629-4631
Practice Address - Street 1:9140 N EAGLESTONE LOOP
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-9426
Practice Address - Country:US
Practice Address - Phone:520-579-0009
Practice Address - Fax:520-579-0009
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-04
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW 13710104100000X
IL149.0209281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker