Provider Demographics
NPI:1760625107
Name:SAFKO, DEBORAH L
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:SAFKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17501 BISCAYNE BLVD
Mailing Address - Street 2:SUITE # 500
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4802
Mailing Address - Country:US
Mailing Address - Phone:786-423-1854
Mailing Address - Fax:
Practice Address - Street 1:17501 BISCAYNE BLVD
Practice Address - Street 2:SUITE # 500
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4802
Practice Address - Country:US
Practice Address - Phone:786-423-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-00-0371103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst