Provider Demographics
NPI:1639229347
Name:NOBLE, DEBORAH A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:A
Last Name:NOBLE
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 1:5467 UPPER MOUTAIN ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1895
Mailing Address - Country:US
Mailing Address - Phone:716-439-7400
Mailing Address - Fax:716-439-7521
Practice Address - Street 1:5467 UPPER MOUTAIN ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1895
Practice Address - Country:US
Practice Address - Phone:716-439-7400
Practice Address - Fax:716-439-7521
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0611131104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD2705Medicare ID - Type Unspecified