Provider Demographics
NPI:1396405361
Name:TIRADO, DEBRA ANN (MA, LAC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:DEBRA
Middle Name:ANN
Last Name:TIRADO
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:FARETRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 GLESS AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3214
Mailing Address - Country:US
Mailing Address - Phone:973-715-7094
Mailing Address - Fax:
Practice Address - Street 1:26 GLESS AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3214
Practice Address - Country:US
Practice Address - Phone:973-715-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00615700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health