Provider Demographics
NPI:1720114184
Name:WHALEN, DEBORAH ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:WHALEN
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 1:3 CALIENTE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9208
Mailing Address - Country:US
Mailing Address - Phone:505-820-0477
Mailing Address - Fax:505-820-0467
Practice Address - Street 1:3 CALIENTE RD STE 7
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9208
Practice Address - Country:US
Practice Address - Phone:505-820-0477
Practice Address - Fax:505-820-0467
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05990111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
059901OtherPROVIDER LICENSE
NYNY5431Medicare ID - Type UnspecifiedPART B