MEDICARE: DEBORAH B. DEACON L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1577-C	AR

General Provider Information

NPI Number	:	1003860362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH B. DEACON L.C.S.W.

Provider Business Mailing Address
First Line	:	331 GOSHEN AVE
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-8933
Country	:	US
Telephone Number	:	501-944-0030
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 MAIN ST
Second Line	:	SUITE 231
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-2872
Country	:	US
Telephone Number	:	501-944-0030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	04/06/2011

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