Provider Demographics
NPI:1780669556
Name:CARNINE, DEBORAH SUE (LISW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:CARNINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 DOUGLAS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6214
Mailing Address - Country:US
Mailing Address - Phone:515-232-7157
Mailing Address - Fax:515-232-7116
Practice Address - Street 1:416 DOUGLAS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6214
Practice Address - Country:US
Practice Address - Phone:515-232-7157
Practice Address - Fax:515-232-7116
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA011081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0198184Medicaid
IA48765Medicare ID - Type Unspecified