Healthcare Provider Details

I. General information

NPI: 1053650952
Provider Name (Legal Business Name): DEBORAH WHALEN LCSW & DEBORAH WHALEN EQUINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JOSE DE LA PAZ
LAMY NM
87540-9609
US

IV. Provider business mailing address

10 JOSE DE LA PAZ
LAMY NM
87540-9609
US

V. Phone/Fax

Practice location:
  • Phone: 917-620-1959
  • Fax:
Mailing address:
  • Phone: 917-620-1959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEBORAH WHALEN
Title or Position: PSYCHOTHERAPIST
Credential: LCSW
Phone: 917-620-1959