Provider Demographics
NPI:1598985665
Name:POOR, DEBORAH DAY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DAY
Last Name:POOR
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 1:6700 S FLORIDA AVE
Mailing Address - Street 2:STE 13
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813
Mailing Address - Country:US
Mailing Address - Phone:863-648-0500
Mailing Address - Fax:863-644-9015
Practice Address - Street 1:6700 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813
Practice Address - Country:US
Practice Address - Phone:863-648-0500
Practice Address - Fax:863-644-9015
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW35841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6026Medicare ID - Type Unspecified