Provider Demographics
NPI:1639294663
Name:LITBERG, DEBORAH ANNE (MSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:LITBERG
Suffix:
Gender:F
Credentials:MSW
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 1003
Mailing Address - Street 2:
Mailing Address - City:GLENEDEN BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97388-1003
Mailing Address - Country:US
Mailing Address - Phone:818-262-9487
Mailing Address - Fax:541-764-9086
Practice Address - Street 1:790 SE HIGHWAY 101 STE A
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-2715
Practice Address - Country:US
Practice Address - Phone:818-262-9487
Practice Address - Fax:541-764-9086
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS251701041C0700X
ORL131561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB225073Medicaid