Healthcare Provider Details

I. General information

NPI: 1275742058
Provider Name (Legal Business Name): DEBRA ANN FLUDD LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 THIRD AVENUE
NY NY
10029
US

IV. Provider business mailing address

1977 POWELL AVENUE
BRONX NY
10472
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6235
  • Fax: 212-828-6145
Mailing address:
  • Phone: 718-597-0503
  • Fax: 212-828-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR033087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: