Provider Demographics
NPI:1700151891
Name:DEGRADO, DEBORAH ANNE (CACIII)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANNE
Last Name:DEGRADO
Suffix:
Gender:F
Credentials:CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9181
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-0181
Mailing Address - Country:US
Mailing Address - Phone:719-254-5239
Mailing Address - Fax:
Practice Address - Street 1:711 BARNES AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2138
Practice Address - Country:US
Practice Address - Phone:719-384-8503
Practice Address - Fax:719-384-5672
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0020792101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)