Provider Demographics
NPI:1912023250
Name:MAGNUS, DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MAGNUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 COUNTY ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5107
Mailing Address - Country:US
Mailing Address - Phone:508-997-0794
Mailing Address - Fax:508-999-6607
Practice Address - Street 1:466 COUNTY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5107
Practice Address - Country:US
Practice Address - Phone:508-997-0794
Practice Address - Fax:508-999-6607
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2132581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA213258OtherLCSW LICENSE