Provider Demographics
NPI:1932118841
Name:DEAN, DEBRA LAURIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LAURIE
Last Name:DEAN
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 1:210 3RD ST W
Mailing Address - Street 2:APT 7308
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8868
Mailing Address - Country:US
Mailing Address - Phone:318-243-5061
Mailing Address - Fax:
Practice Address - Street 1:2290 CATTLEMEN RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6277
Practice Address - Country:US
Practice Address - Phone:941-893-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA81691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA004148046Medicaid
LA3A196Medicare PIN