Provider Demographics
NPI:1285075531
Name:MANCINI, DEBORAH (MSED)
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:
Last Name:MANCINI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:GARTIAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:80 WOODROW ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312
Mailing Address - Country:US
Mailing Address - Phone:718-356-0008
Mailing Address - Fax:
Practice Address - Street 1:80 WOODROW RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-1313
Practice Address - Country:US
Practice Address - Phone:718-356-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252737031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist