Provider Demographics
NPI:1922547280
Name:NERETICH, DEBORAH F (LMSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:F
Last Name:NERETICH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 35TH AVE
Mailing Address - Street 2:APT. A41
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-4660
Mailing Address - Country:US
Mailing Address - Phone:347-563-8214
Mailing Address - Fax:
Practice Address - Street 1:4404 QUEENS BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2406
Practice Address - Country:US
Practice Address - Phone:718-706-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050974-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical