Provider Demographics
NPI:1689401549
Name:PELOSI, DEBRA MARIE
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:MARIE
Last Name:PELOSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NW 125TH DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2718
Mailing Address - Country:US
Mailing Address - Phone:352-332-1330
Mailing Address - Fax:
Practice Address - Street 1:810 NW 125TH DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2718
Practice Address - Country:US
Practice Address - Phone:352-332-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health