Provider Demographics
NPI:1518207851
Name:COLLETTE-CROMP, DEBORAH A (MSED)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:COLLETTE-CROMP
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:GIROUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:691 COUNTY ROUTE 24
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-3956
Mailing Address - Country:US
Mailing Address - Phone:518-569-7124
Mailing Address - Fax:
Practice Address - Street 1:691 COUNTY ROUTE 24
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-3956
Practice Address - Country:US
Practice Address - Phone:518-569-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-24
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY595106051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
03760836OtherMMIS
AN72OtherETIN
00E8OtherETIN