Healthcare Provider Details

I. General information

NPI: 1366994873
Provider Name (Legal Business Name): DEBORAH ANN PUTNAM MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS DEBORAH ANN VOLKER

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 HORTON ST
LANSING MI
48912-2808
US

IV. Provider business mailing address

210 HORTON ST
LANSING MI
48912-2808
US

V. Phone/Fax

Practice location:
  • Phone: 517-410-0466
  • Fax:
Mailing address:
  • Phone: 517-410-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090455
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: