Provider Demographics
NPI:1821020165
Name:BIRNBAUM, DEBORAH RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:RUTH
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W 96TH ST APT 8Q
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6270
Mailing Address - Country:US
Mailing Address - Phone:212-678-4758
Mailing Address - Fax:
Practice Address - Street 1:275 W 96TH ST APT 8Q
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6270
Practice Address - Country:US
Practice Address - Phone:212-678-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430831Medicaid
NY01430831Medicaid