Provider Demographics
NPI:1982013223
Name:DEMUTH, DEBRA ELLEN (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ELLEN
Last Name:DEMUTH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:DEMUTH
Other - Last Name:MCGRANAGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:29 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1287
Mailing Address - Country:US
Mailing Address - Phone:413-598-5382
Mailing Address - Fax:
Practice Address - Street 1:29 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1287
Practice Address - Country:US
Practice Address - Phone:413-598-5382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1171961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical