Provider Demographics
NPI:1104186352
Name:EHRENBERG, DEBRA LEAH
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEAH
Last Name:EHRENBERG
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 1:124 CUMBERLAND PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1334
Mailing Address - Country:US
Mailing Address - Phone:347-524-6121
Mailing Address - Fax:718-337-2268
Practice Address - Street 1:124 CUMBERLAND PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1334
Practice Address - Country:US
Practice Address - Phone:347-524-6121
Practice Address - Fax:718-337-2268
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014061225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist