Provider Demographics
NPI:1184769192
Name:TAYLOR, DEBORAH MAUREEN (MS, LMFT, LMHC)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:MAUREEN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MS, LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 SE STRAIT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-4640
Mailing Address - Country:US
Mailing Address - Phone:772-834-1373
Mailing Address - Fax:
Practice Address - Street 1:649 SE STRAIT AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-4640
Practice Address - Country:US
Practice Address - Phone:772-834-1373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2917101YM0800X
FLMT1452106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33694OtherCIGNA BEHAVIORAL HEALTHCA