Provider Demographics
NPI:1831644889
Name:DIAS FERREIRA, DEBORA (LSCSW)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:DIAS FERREIRA
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3405
Mailing Address - Country:US
Mailing Address - Phone:816-221-0305
Mailing Address - Fax:816-221-9121
Practice Address - Street 1:2546 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2743
Practice Address - Country:US
Practice Address - Phone:816-221-0305
Practice Address - Fax:816-221-9121
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100240930AMedicaid