Healthcare Provider Details

I. General information

NPI: 1154339950
Provider Name (Legal Business Name): DEBORAH FLOYD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA FLOYD LICSW

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BELMONT ST RM 44
WORCESTER MA
01605-2964
US

IV. Provider business mailing address

187 PILGRIM DR
HOLDEN MA
01520-1928
US

V. Phone/Fax

Practice location:
  • Phone: 508-219-7189
  • Fax:
Mailing address:
  • Phone: 508-853-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1032612
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier62-00531
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerEVERCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: