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NPI Code Detail

MEDICARE: DEBRA LEE RETZLAFF

MEDICARE: DEBRA LEE RETZLAFF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker068990NY

General Provider Information

NPI Number : 1164508701
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA LEE RETZLAFF
Provider Business Mailing Address
First Line : 2031 OLD COOMER RD
Second Line :
City : BURT
State : NY
Zip : 14028-9735
Country : US
Telephone Number : 716-778-8337
Fax Number :
Provider Business Practice Location Address
First Line : 89 RIVER RD # B
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-5713
Country : US
Telephone Number : 716-693-9961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 07/08/2007

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