Provider Demographics
NPI:1346411550
Name:LANDRY, DEBORAH JO S (LCPC-C)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH JO
Middle Name:S
Last Name:LANDRY
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOLLY ST
Mailing Address - Street 2:211
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8867
Mailing Address - Country:US
Mailing Address - Phone:207-699-8289
Mailing Address - Fax:
Practice Address - Street 1:15 HOLLY ST
Practice Address - Street 2:211
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8867
Practice Address - Country:US
Practice Address - Phone:207-699-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health