Provider Demographics
NPI:1295891984
Name:NORDSTROM, DEBORAH MARY (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:MARY
Last Name:NORDSTROM
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 1:111 WEST MAIN STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34450
Mailing Address - Country:US
Mailing Address - Phone:352-476-3164
Mailing Address - Fax:352-423-1351
Practice Address - Street 1:111 W MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34450-4807
Practice Address - Country:US
Practice Address - Phone:352-476-3164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10269971041C0700X
TN56081041C0700X
FL128451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07591OtherBLUE CROSS BLUE SHIELD
MA1012450OtherFALLON COMM HP