MEDICARE: DEBRA THATCHER LCSW-R

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	101YM0800X	Mental Health Counselor	081915	NY

General Provider Information

NPI Number	:	1437309739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA THATCHER LCSW-R

Provider Business Mailing Address
First Line	:	336 W CENTER ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-1315
Country	:	US
Telephone Number	:	607-483-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 W CENTER ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-1315
Country	:	US
Telephone Number	:	607-483-5366
Fax Number	:

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

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	10/21/2021

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