Provider Demographics
NPI:1851640148
Name:NELSON, DEBRA SHEPARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SHEPARD
Last Name:NELSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-0002
Mailing Address - Country:US
Mailing Address - Phone:860-788-3231
Mailing Address - Fax:888-844-4036
Practice Address - Street 1:199 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-0002
Practice Address - Country:US
Practice Address - Phone:860-788-3231
Practice Address - Fax:888-844-4036
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical