Provider Demographics
NPI:1730256553
Name:WADE, DEBRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:WADE
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 1:329 BROWER AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-594-6955
Mailing Address - Fax:516-594-6955
Practice Address - Street 1:1722 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1471
Practice Address - Country:US
Practice Address - Phone:347-713-3316
Practice Address - Fax:516-594-6955
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03253011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5A791Medicare ID - Type Unspecified