Provider Demographics
NPI:1093849234
Name:BEEFERMAN, DEBRA JENNIFER (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:JENNIFER
Last Name:BEEFERMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19501 E COUNTRY CLUB DR APT 204
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2594
Mailing Address - Country:US
Mailing Address - Phone:305-936-1918
Mailing Address - Fax:
Practice Address - Street 1:19501 E COUNTRY CLUB DR APT 204
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2594
Practice Address - Country:US
Practice Address - Phone:305-936-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891430300Medicaid