Provider Demographics
NPI:1437227709
Name:WAYNE, DEBRA GILBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:GILBERT
Last Name:WAYNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 AMITY RD
Mailing Address - Street 2:STE 213
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2200
Mailing Address - Country:US
Mailing Address - Phone:203-397-0129
Mailing Address - Fax:
Practice Address - Street 1:264 AMITY RD
Practice Address - Street 2:STE 213
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2200
Practice Address - Country:US
Practice Address - Phone:203-397-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11623987OtherCAQH ID NUMBER