Healthcare Provider Details

I. General information

NPI: 1881991255
Provider Name (Legal Business Name): DEBORAH D CHATHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 NORTON STREET JORDAN HEALTH AT FRANKLIN
ROCHESTER NY
14621
US

IV. Provider business mailing address

82 HOLLAND ST HR CREDENTIALING DEPT
ROCHESTER NY
14605-2131
US

V. Phone/Fax

Practice location:
  • Phone: 585-324-3750
  • Fax:
Mailing address:
  • Phone: 585-423-2816
  • Fax: 585-423-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR024199-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR024199
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: