Provider Demographics
NPI:1659518637
Name:SHARON-LISS, DEBBIE MAZAL (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:MAZAL
Last Name:SHARON-LISS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MISS
Other - First Name:DEBBIE
Other - Middle Name:MAZAL
Other - Last Name:SHARON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS-CCC/SLP
Mailing Address - Street 1:2136 E 63RD ST
Mailing Address - Street 2:DEBBIE SHARON-LISS
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6302
Mailing Address - Country:US
Mailing Address - Phone:917-603-3551
Mailing Address - Fax:516-341-0563
Practice Address - Street 1:3321 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5421
Practice Address - Country:US
Practice Address - Phone:917-603-3551
Practice Address - Fax:516-341-0563
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010528235Z00000X
NY010528-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist