Provider Demographics
NPI:1902992506
Name:LEBEAUX, DEBORAH P (LICSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:P
Last Name:LEBEAUX
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-3319
Mailing Address - Country:US
Mailing Address - Phone:508-842-8684
Mailing Address - Fax:
Practice Address - Street 1:18 LYMAN STREET SUITE C
Practice Address - Street 2:
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1050571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1854054Medicaid
MAP03685OtherBLUE CROSS
MA641611OtherTUFTS
MAP03685OtherBLUE CROSS
MAP23530Medicare PIN