Provider Demographics
NPI:1891898417
Name:ABBEY, DEBORAH KAY (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:ABBEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:KAY
Other - Last Name:MOULDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1929
Mailing Address - Country:US
Mailing Address - Phone:701-234-4141
Mailing Address - Fax:701-234-4137
Practice Address - Street 1:100 4TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1929
Practice Address - Country:US
Practice Address - Phone:701-234-4141
Practice Address - Fax:701-234-4137
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137711041C0700X
ND29101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP32933OtherHEALTHPARTNERS
ND19138Medicaid
ND25390Medicare ID - Type Unspecified
NDN712562Medicare PIN