Provider Demographics
NPI:1902893761
Name:JAVORSKY, DEBBIE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:J
Last Name:JAVORSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:J
Other - Last Name:RAWLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3300
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03105-3300
Mailing Address - Country:US
Mailing Address - Phone:603-645-5977
Mailing Address - Fax:603-645-5980
Practice Address - Street 1:138 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2512
Practice Address - Country:US
Practice Address - Phone:603-645-5977
Practice Address - Fax:603-645-5980
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH998103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH06Y001395NH01OtherANTHEM
NH30422392Medicaid
NH30422392Medicaid