Provider Demographics
NPI:1184663288
Name:LANDIS, DEBRA MORENO (LCSW, LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:MORENO
Last Name:LANDIS
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2116
Mailing Address - Country:US
Mailing Address - Phone:816-363-1898
Mailing Address - Fax:816-822-7711
Practice Address - Street 1:2 E 59TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2116
Practice Address - Country:US
Practice Address - Phone:816-363-1898
Practice Address - Fax:816-822-7711
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0053191041C0700X
KS31231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO28055011OtherBCBSKC
MO4997664000Medicaid