Provider Demographics
NPI:1578138756
Name:MAGILL, DEBORA BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:BETH
Last Name:MAGILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E WISCONSIN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4212
Mailing Address - Country:US
Mailing Address - Phone:414-224-3737
Mailing Address - Fax:414-224-1522
Practice Address - Street 1:229 E WISCONSIN AVE STE 600
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4212
Practice Address - Country:US
Practice Address - Phone:414-224-3737
Practice Address - Fax:414-224-1522
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9504-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9504-123OtherSTATE OF WISCONSIN