Provider Demographics
NPI:1679746440
Name:HUDOBENKO, DEBRA ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANNE
Last Name:HUDOBENKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANNE
Other - Last Name:DESCAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:88 MATTHEW ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1414
Mailing Address - Country:US
Mailing Address - Phone:035-182-9772
Mailing Address - Fax:203-757-9753
Practice Address - Street 1:40 UNION CITY RD STE 2B
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712
Practice Address - Country:US
Practice Address - Phone:475-235-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0071431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical