MEDICARE: DR. DEBORAH CHANDLER PH.D.

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	103TC0700X	Clinical Psychologist	010922	NY
2	103TC0700X	Clinical Psychologist	PSY12289	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548244015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH CHANDLER PH.D.

Provider Business Mailing Address
First Line	:	5197 MAIN STREET
Second Line	:	POST OFFICE BOX N
City	:	SOUTH FALLSBURG
State	:	NY
Zip	:	12779-2013
Country	:	US
Telephone Number	:	845-436-5107
Fax Number	:	845-436-5208

Provider Business Practice Location Address
First Line	:	5197 MAIN ST
Second Line	:
City	:	SOUTH FALLSBURG
State	:	NY
Zip	:	12779-2013
Country	:	US
Telephone Number	:	845-436-5107
Fax Number	:	845-436-5208

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/03/2010

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