Provider Demographics
NPI:1659697217
Name:DATZ, DEBORAH (LPC, NCSP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DATZ
Suffix:
Gender:F
Credentials:LPC, NCSP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:DATZ
Other - Last Name:HERSCHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, NCSP
Mailing Address - Street 1:39 SHERMAN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5825
Mailing Address - Country:US
Mailing Address - Phone:203-255-2211
Mailing Address - Fax:203-256-9225
Practice Address - Street 1:39 SHERMAN CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5825
Practice Address - Country:US
Practice Address - Phone:203-255-2211
Practice Address - Fax:203-256-9225
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1592101YP2500X
MA906103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool