Provider Demographics
NPI:1417408287
Name:O'CONNELL, DEBRA
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:EINSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:76 EXCELSIOR AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-5209
Mailing Address - Country:US
Mailing Address - Phone:518-892-1433
Mailing Address - Fax:
Practice Address - Street 1:76 EXCELSIOR AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-5209
Practice Address - Country:US
Practice Address - Phone:518-892-1433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist