Provider Demographics
NPI:1255446829
Name:STAUFFER, DEBORAH RAE (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RAE
Last Name:STAUFFER
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 1:17 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-5459
Mailing Address - Country:US
Mailing Address - Phone:717-775-3380
Mailing Address - Fax:717-775-3382
Practice Address - Street 1:17 S 19TH ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-5459
Practice Address - Country:US
Practice Address - Phone:717-775-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3490101YM0800X
PACW0186101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1037187OtherCIGNA
ME127160100Medicaid
ME017061OtherANTHEM