Healthcare Provider Details

I. General information

NPI: 1194757211
Provider Name (Legal Business Name): DEBORAH SUE HAMBRIGHT ACSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 E FT WAYNE ST
WARSAW IN
46580-3338
US

IV. Provider business mailing address

PO BOX 2018
WARSAW IN
46581-2018
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-3030
  • Fax: 574-269-4646
Mailing address:
  • Phone: 574-269-3030
  • Fax: 574-269-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34000675A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: