Provider Demographics
NPI:1770014359
Name:OUIMETTE, DEBORA
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:OUIMETTE
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 1:45 CONGRESS ST
Mailing Address - Street 2:SUITE 4120
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5579
Mailing Address - Country:US
Mailing Address - Phone:978-741-7316
Mailing Address - Fax:978-741-7340
Practice Address - Street 1:45 CONGRESS ST
Practice Address - Street 2:SUITE 4120
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5579
Practice Address - Country:US
Practice Address - Phone:978-741-7316
Practice Address - Fax:978-741-7340
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1167091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical