MEDICARE: MISS DEBORAH UTTERBACK LCSW-S

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
1	1041C0700X	Clinical Social Worker	54545	TX

General Provider Information

NPI Number	:	1326477076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DEBORAH UTTERBACK LCSW-S

Provider Business Mailing Address
First Line	:	PO BOX 171779
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-1163
Country	:	US
Telephone Number	:	214-586-0213
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 PEMBERTON HILL RD UNIT 4
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75217-5209
Country	:	US
Telephone Number	:	972-412-1099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	03/26/2026

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