Provider Demographics
NPI:1528119294
Name:KINGSLEY, DEBRA JOAN (MENTAL HEALTH COUNSE)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JOAN
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:MENTAL HEALTH COUNSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1714
Mailing Address - Country:US
Mailing Address - Phone:631-473-7366
Mailing Address - Fax:
Practice Address - Street 1:646 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2235
Practice Address - Country:US
Practice Address - Phone:631-365-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003628101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health