Basic Information
Provider Information | |||||||||
NPI: | 1245879816 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DELLUOMO | ||||||||
FirstName: | DEBORAH | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GAROFALO | ||||||||
OtherFirstName: | DEBORAH | ||||||||
OtherMiddleName: | ANN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1 THEALL RD | ||||||||
Address2: |   | ||||||||
City: | RYE | ||||||||
State: | NY | ||||||||
PostalCode: | 105801404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9148488030 | ||||||||
FaxNumber: | 9148488031 | ||||||||
Practice Location | |||||||||
Address1: | 1 THEALL RD | ||||||||
Address2: |   | ||||||||
City: | RYE | ||||||||
State: | NY | ||||||||
PostalCode: | 105801404 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9148488030 | ||||||||
FaxNumber: | 9148488031 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/31/2019 | ||||||||
LastUpdateDate: | 01/25/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/25/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 075344 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
ID Information
ID | Type | State | Issuer | Description | PENDING | 05 | NY |   | MEDICAID |