Provider Demographics
NPI:1508111501
Name:MOOD, DEBORAH ELLEN WITSKEN (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN WITSKEN
Last Name:MOOD
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 1:13121 E 17TH AVE
Mailing Address - Street 2:C234- JFK PARTNERS
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13121 E 17TH AVE
Practice Address - Street 2:C234- JFK PARTNERS
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2535
Practice Address - Country:US
Practice Address - Phone:303-724-7659
Practice Address - Fax:303-724-7661
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3732103T00000X, 103TC2200X, 103TM1800X, 103TS0200X
COPSY.0003732103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool