Provider Demographics
NPI:1821610015
Name:BAGG, DEBORAH CLAIRE (LMHC, MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CLAIRE
Last Name:BAGG
Suffix:
Gender:F
Credentials:LMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 STERLING PL APT 1D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4829
Mailing Address - Country:US
Mailing Address - Phone:646-509-7817
Mailing Address - Fax:
Practice Address - Street 1:632 STERLING PL APT 1D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4829
Practice Address - Country:US
Practice Address - Phone:646-509-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health