Provider Demographics
NPI:1164144903
Name:KERINS, DEANNA ELISABETH
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:ELISABETH
Last Name:KERINS
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 1:664 ORANGEBURG RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2830
Mailing Address - Country:US
Mailing Address - Phone:845-735-3066
Mailing Address - Fax:
Practice Address - Street 1:664 ORANGEBURG RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2830
Practice Address - Country:US
Practice Address - Phone:845-735-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY033277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033277OtherLICENSE NUMBER