MEDICARE: DEBBY JEAN

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	092449	NY

General Provider Information

NPI Number	:	1326707084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBY JEAN

Provider Business Mailing Address
First Line	:	116 BEDELL ST
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-5008
Country	:	US
Telephone Number	:	347-819-4533
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 BEDELL ST
Second Line	:
City	:	WEST BABYLON
State	:	NY
Zip	:	11704-5008
Country	:	US
Telephone Number	:	347-819-4533
Fax Number	:

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

Provider Enumeration Date	:	12/09/2021
Last Update Date	:	12/09/2021

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