Provider Demographics
NPI:1326094038
Name:TELAAK, DEBORAH (MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:TELAAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BUCYRUS DR
Mailing Address - Street 2:MANAGED CARE DEPARTMENT
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1944
Mailing Address - Country:US
Mailing Address - Phone:716-691-8913
Mailing Address - Fax:716-691-7013
Practice Address - Street 1:29 BUCYRUS DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1944
Practice Address - Country:US
Practice Address - Phone:716-691-8913
Practice Address - Fax:716-691-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000506354003OtherCOMMUNITY BLUE
NY00030241501OtherUNIVERA