Provider Demographics
NPI:1720114630
Name:MATTISON, DEBORAH J (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:MATTISON
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 1:33 KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1207
Mailing Address - Country:US
Mailing Address - Phone:716-517-3655
Mailing Address - Fax:
Practice Address - Street 1:1200 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:716-517-3655
Practice Address - Fax:716-517-3738
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02859411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical