Provider Demographics
NPI:1811973381
Name:ACITO, DEBORAH LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:ACITO
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 1:601 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2317
Mailing Address - Country:US
Mailing Address - Phone:812-353-9568
Mailing Address - Fax:812-353-9318
Practice Address - Street 1:445 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5004
Practice Address - Country:US
Practice Address - Phone:812-353-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000846A101YM0800X
IN34000849A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN549000NMedicare ID - Type UnspecifiedMEDICARE