Provider Demographics
NPI:1952656415
Name:BOUSQET, DEBORAH J (MS OF ED)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:J
Last Name:BOUSQET
Suffix:
Gender:F
Credentials:MS OF ED
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OF ED
Mailing Address - Street 1:26 TODD CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4224
Mailing Address - Country:US
Mailing Address - Phone:631-553-9461
Mailing Address - Fax:631-427-1850
Practice Address - Street 1:26 TODD CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4224
Practice Address - Country:US
Practice Address - Phone:631-553-9461
Practice Address - Fax:631-427-1850
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist