Active NPI
Debra Ann Fader, MS, LMHC
- Mental Health Counselor
- Matamoras, PA
National Provider Identifier
1033728522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 002268
- Practice address
- 106 Avenue C
Matamoras, PA 18336-1046 - Phone
- (570) 877-0488
- NPI assigned
- Jul 30, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 002268 | NY | Primary |
Addresses
Primary practice location
106 Avenue C
Matamoras, PA 18336-1046
Mailing address
106 Avenue C
Matamoras, PA 18336-1046
Phone (570) 877-0488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002268 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596067200000",
"number": "1033728522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 AVENUE C",
"city": "MATAMORAS",
"state": "PA",
"postal_code": "183361046",
"telephone_number": "570-877-0488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 AVENUE C",
"city": "MATAMORAS",
"state": "PA",
"postal_code": "183361046",
"telephone_number": "570-877-0488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FADER",
"first_name": "DEBRA",
"middle_name": "ANN",
"credential": "MS, LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-30",
"last_updated": "2020-07-30",
"certification_date": "2020-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "002268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.