Provider Demographics
NPI:1679677603
Name:HEWITT, DEBORAH M (LPC, LADC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:M
Last Name:HEWITT
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HAZARD AVE
Mailing Address - Street 2:BUILDING 2, SUITE 7
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4585
Mailing Address - Country:US
Mailing Address - Phone:860-763-4465
Mailing Address - Fax:860-763-4467
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:BUILDING 2, SUITE 7
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4585
Practice Address - Country:US
Practice Address - Phone:860-763-4465
Practice Address - Fax:860-763-4467
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT146101YA0400X
CT267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008059004Medicaid