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General NPI Number Information
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NPI Number | 1073066320
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Entity Type | Individual
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Provider Name | DEBRA R MAMMADOVA LP
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Gender | Female
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 02/17/2026
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Provider Practice Location Address
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Address Line | 117 S LEXINGTON ST STE 100
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City | HARRISONVILLE
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State | MO
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Zip | 64701-2444
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Country | US
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Telephone | 414-839-4579
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Fax | 855-202-6591
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Provider Business Mailing Address
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Address Line | 709 N 6TH ST STE 219
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City | KANSAS CITY
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State | KS
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Zip | 66101-3031
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Country | US
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Telephone | 414-839-4579
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Fax | 855-202-6591
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 02979
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2018042701
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License Number State | MO
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