Provider Demographics
NPI:1174655260
Name:BALL, DEBORAH FRANCES (MSW LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:FRANCES
Last Name:BALL
Suffix:
Gender:F
Credentials:MSW LCSWR
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:FRANCES
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW R
Mailing Address - Street 1:3510 SANDHILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NY
Mailing Address - Zip Code:14505
Mailing Address - Country:US
Mailing Address - Phone:315-926-0815
Mailing Address - Fax:315-946-7005
Practice Address - Street 1:1519 NYE ROAD
Practice Address - Street 2:WAYNE BEHAVIORAL HEALTH NETWORK
Practice Address - City:LYONS
Practice Address - State:NY
Practice Address - Zip Code:14489
Practice Address - Country:US
Practice Address - Phone:315-946-5722
Practice Address - Fax:315-946-7066
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0259981104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025998Medicaid
17412NMedicare ID - Type Unspecified