Healthcare Provider Details

I. General information

NPI: 1720867559
Provider Name (Legal Business Name): DEBORAH ANN ATSIDIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH ATSIDIS

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/01/2024
Certification Date: 09/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 VIRGINIA AVE
AMBRIDGE PA
15003-1604
US

IV. Provider business mailing address

413 VIRGINIA AVE
AMBRIDGE PA
15003-1604
US

V. Phone/Fax

Practice location:
  • Phone: 239-822-0118
  • Fax:
Mailing address:
  • Phone: 239-822-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number039610
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00946945
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW141638
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089.0136018
License Number StateVT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: