Provider Demographics
NPI:1326051731
Name:NUSSBAUM, DEBRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92140 OVERSEAS HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2636
Mailing Address - Country:US
Mailing Address - Phone:305-853-3284
Mailing Address - Fax:305-853-3286
Practice Address - Street 1:92140 OVERSEAS HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2636
Practice Address - Country:US
Practice Address - Phone:305-853-3284
Practice Address - Fax:305-853-3286
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7336104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker