Provider Demographics
NPI:1346612645
Name:WADE, DEBORAH (CASAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-3351
Mailing Address - Country:US
Mailing Address - Phone:212-966-9537
Mailing Address - Fax:212-584-5450
Practice Address - Street 1:598 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3351
Practice Address - Country:US
Practice Address - Phone:212-966-9537
Practice Address - Fax:212-584-5450
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)