Provider Demographics
NPI:1548739741
Name:PETERS, DEBRA (CASAC-T, CARC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:CASAC-T, CARC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-0234
Mailing Address - Country:US
Mailing Address - Phone:631-926-2362
Mailing Address - Fax:
Practice Address - Street 1:550 WADING RIVER RD
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3447
Practice Address - Country:US
Practice Address - Phone:631-926-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)