Provider Demographics
NPI:1720234321
Name:LIDOV, DEBORA ANN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:ANN
Last Name:LIDOV
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 EASTERN PKWY
Mailing Address - Street 2:5F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6055
Mailing Address - Country:US
Mailing Address - Phone:718-399-3377
Mailing Address - Fax:
Practice Address - Street 1:333 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5803
Practice Address - Country:US
Practice Address - Phone:718-533-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0776421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical