Provider Demographics
NPI:1689946089
Name:RADZIK-HERSTEIN, DEBRA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:RADZIK-HERSTEIN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14147 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1936
Mailing Address - Country:US
Mailing Address - Phone:646-269-9842
Mailing Address - Fax:718-261-4938
Practice Address - Street 1:14147 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1936
Practice Address - Country:US
Practice Address - Phone:646-269-9842
Practice Address - Fax:718-261-4938
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY845396101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool