Healthcare Provider Details

I. General information

NPI: 1740583046
Provider Name (Legal Business Name): DEBRA K BOROFF MS:ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 4TH AVE STE 32
KEARNEY NE
68845-2884
US

IV. Provider business mailing address

4111 4TH AVE STE 32
KEARNEY NE
68845-2884
US

V. Phone/Fax

Practice location:
  • Phone: 308-234-6029
  • Fax:
Mailing address:
  • Phone: 308-234-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9278
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: