Provider Demographics
NPI:1518088467
Name:PRIEBE, DEBORAH ANN (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:PRIEBE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NEIL DR
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1538
Mailing Address - Country:US
Mailing Address - Phone:631-656-8505
Mailing Address - Fax:
Practice Address - Street 1:2780 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-2124
Practice Address - Country:US
Practice Address - Phone:631-361-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012593-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical