Provider Demographics
NPI:1215389432
Name:KOEPPEL, DEBORAH (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:KOEPPEL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:WALTZER-KOEPPEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:160 EAST 34TH STREET - NYU PERLMUTTER CANCER CENTER
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9994
Mailing Address - Country:US
Mailing Address - Phone:212-731-5108
Mailing Address - Fax:121-273-1564
Practice Address - Street 1:160 EAST 34TH STREET - DEBORAH KOEPPEL
Practice Address - Street 2:ROOM 1105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9994
Practice Address - Country:US
Practice Address - Phone:212-731-5108
Practice Address - Fax:121-273-1564
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049565-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR049565-1OtherSOCIAL WORK LICENSE