Provider Demographics
NPI:1225184252
Name:DEBORAH ANN WILLBUR LCSW PA
Entity Type:Organization
Organization Name:DEBORAH ANN WILLBUR LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILLBUR
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:407-645-0028
Mailing Address - Street 1:2150 PARK AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789
Mailing Address - Country:US
Mailing Address - Phone:407-645-0028
Mailing Address - Fax:407-645-3507
Practice Address - Street 1:2150 PARK AVE NORTH
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-645-0028
Practice Address - Fax:407-645-3507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00015011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty