Provider Demographics
NPI:1558398131
Name:ILBERMAN, DEBRA (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ILBERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3207
Mailing Address - Country:US
Mailing Address - Phone:516-637-2703
Mailing Address - Fax:
Practice Address - Street 1:26 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3207
Practice Address - Country:US
Practice Address - Phone:516-637-2703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0330971041C0700X
NYR0030971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01382663Medicaid
NY70119VMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY01382663Medicaid
NY70119AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER