Provider Demographics
NPI:1871640094
Name:BERREBBI, DENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENA
Middle Name:
Last Name:BERREBBI
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 1:2 DERBY RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4204
Mailing Address - Country:US
Mailing Address - Phone:516-849-9075
Mailing Address - Fax:
Practice Address - Street 1:1025 NORTHERN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1506
Practice Address - Country:US
Practice Address - Phone:516-849-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014446103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL9531Medicare ID - Type Unspecified
NY518047Medicare UPIN