Provider Demographics
NPI:1528292687
Name:LEVINE, DEBRA (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:DEBRA
Other - Middle Name:ELYCE
Other - Last Name:FIRESTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 DUANE ST
Mailing Address - Street 2:APT 10 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-3601
Mailing Address - Country:US
Mailing Address - Phone:917-388-6441
Mailing Address - Fax:
Practice Address - Street 1:105 DUANE ST
Practice Address - Street 2:APT 10 A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-3601
Practice Address - Country:US
Practice Address - Phone:917-388-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016121-1235Z00000X
NJ41YS00860500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist