Provider Demographics
NPI:1700016748
Name:DOMBROWSKI, DEBRA LYNN (MSED, MPS)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:DOMBROWSKI
Suffix:
Gender:F
Credentials:MSED, MPS
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:SANTORO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED, MPS
Mailing Address - Street 1:111 SMITHTOWN BYP
Mailing Address - Street 2:SUITE 121
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2524
Mailing Address - Country:US
Mailing Address - Phone:631-838-7801
Mailing Address - Fax:631-979-0438
Practice Address - Street 1:29 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5612
Practice Address - Country:US
Practice Address - Phone:631-499-1237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292221103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool