Healthcare Provider Details

I. General information

NPI: 1245482512
Provider Name (Legal Business Name): DEBORAH LYNNE HARADON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2008
Last Update Date: 10/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ROGERS ST
ULSTER PARK NY
12487-5015
US

IV. Provider business mailing address

220 ROGERS ST
ULSTER PARK NY
12487-5015
US

V. Phone/Fax

Practice location:
  • Phone: 845-485-7237
  • Fax: 845-339-2462
Mailing address:
  • Phone: 845-485-7237
  • Fax: 845-339-2462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04126401
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: