Provider Demographics
NPI:1730193418
Name:GORMAN, DEBORAH (LCSW-R)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3043 STATE ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-9632
Mailing Address - Country:US
Mailing Address - Phone:518-747-2284
Mailing Address - Fax:518-747-2253
Practice Address - Street 1:3043 STATE ROUTE 4
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-9632
Practice Address - Country:US
Practice Address - Phone:518-747-2284
Practice Address - Fax:518-747-2253
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000616481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000409117001OtherEMPIRE BC/BS
NYP01430434OtherMEDICARE RAIL ROAD
040426031840OtherFIDELIS
000409117001OtherMEDICARE SENIOR BLUE
000409117001OtherBLUE SHIELD OF NORTHEASTERN NEW YORK
11623959OtherCAQH
000409117001OtherHEALTHNOW INTEGRATED
NH1731OtherBC/BS
000409117001OtherEMPIRE BC/BS BLUE CARD
NY00069274Medicaid
53088OtherMVP
11623959OtherCAQH
53088OtherMVP