Provider Demographics
NPI:1386766178
Name:LILIENFELD, DEBRA S
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:LILIENFELD
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 1:30 COPLEY RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3209
Mailing Address - Country:US
Mailing Address - Phone:914-834-5789
Mailing Address - Fax:
Practice Address - Street 1:30 COPLEY RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3209
Practice Address - Country:US
Practice Address - Phone:914-834-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO31977-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS4289OtherOXFORD