Provider Demographics
NPI:1881860427
Name:TOMCZAK, DEBORAH A (MS, LLP, LMSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:A
Last Name:TOMCZAK
Suffix:
Gender:F
Credentials:MS, LLP, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W CEDAR ST STE 4
Mailing Address - Street 2:PO BOX 274
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9550
Mailing Address - Country:US
Mailing Address - Phone:989-846-4991
Mailing Address - Fax:989-846-4991
Practice Address - Street 1:806 W CEDAR ST
Practice Address - Street 2:SUITE 4
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9550
Practice Address - Country:US
Practice Address - Phone:989-846-4991
Practice Address - Fax:989-846-4991
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002798103TC0700X
MI68010655101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI492336000OtherMAGELLAN