Provider Demographics
NPI:1255500955
Name:MAR, DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MAR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:RANILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:GRIFFIN HOSPITAL
Mailing Address - Street 2:130 DIVISION STREET
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418
Mailing Address - Country:US
Mailing Address - Phone:203-732-7550
Mailing Address - Fax:203-732-1550
Practice Address - Street 1:GRIFFIN HOSPITAL
Practice Address - Street 2:130 DIVISION STREET
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-732-7550
Practice Address - Fax:203-732-1550
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048741041C0700X
CT48741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004025219Medicaid
CT004874OtherLICENSE