Provider Demographics
NPI:1801027586
Name:DOODKEVITCH, DEBRA MARCUS (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARCUS
Last Name:DOODKEVITCH
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:MARCUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5530 KINGS ROW CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4658
Mailing Address - Country:US
Mailing Address - Phone:702-219-5046
Mailing Address - Fax:702-442-7190
Practice Address - Street 1:5600 SPRING MOUNTAIN RD
Practice Address - Street 2:STE 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8823
Practice Address - Country:US
Practice Address - Phone:702-228-8236
Practice Address - Fax:702-442-7190
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5682-C1041C0700X
NYCNTH#200510247200000X
NV5557-N104100000X
CALCS87481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCQ537AMedicare PIN