Provider Demographics
NPI:1619036308
Name:GREENHAM, DEBORAH JEANNE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:JEANNE
Last Name:GREENHAM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:JEANNE
Other - Last Name:SEEGERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21785 DALEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3901
Mailing Address - Country:US
Mailing Address - Phone:248-449-7250
Mailing Address - Fax:
Practice Address - Street 1:4255 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44128-2811
Practice Address - Country:US
Practice Address - Phone:216-292-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 23881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11490120OtherCAQH