Provider Demographics
NPI:1568523603
Name:CIRRINCIONE, DEBRA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:CIRRINCIONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 BEACH 144TH ST
Mailing Address - Street 2:
Mailing Address - City:NEPONSIT
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1119
Mailing Address - Country:US
Mailing Address - Phone:347-866-5559
Mailing Address - Fax:718-634-9456
Practice Address - Street 1:11412 BEACH CHANNEL DR
Practice Address - Street 2:SUITE # 2
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2215
Practice Address - Country:US
Practice Address - Phone:718-438-6690
Practice Address - Fax:718-634-9456
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010921-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010921-1OtherLICENSE
NY01484468Medicaid
NY112912OtherVBH
NY6801134002OtherGHI
NY6801134002OtherGHI