Provider Demographics
NPI:1972832632
Name:CHECKETTS, DEBORAH LEISHMAN (LMSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LEISHMAN
Last Name:CHECKETTS
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 1:27 FATHER PETERS LN
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-2214
Mailing Address - Country:US
Mailing Address - Phone:203-972-7307
Mailing Address - Fax:203-972-7419
Practice Address - Street 1:217 E. 87TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3200
Practice Address - Country:US
Practice Address - Phone:212-876-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082477-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker