Provider Demographics
NPI:1205081668
Name:GROARK, DEBORAH S (MA,CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:S
Last Name:GROARK
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SHORE RD
Mailing Address - Street 2:APT. 30
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4237
Mailing Address - Country:US
Mailing Address - Phone:516-889-4691
Mailing Address - Fax:
Practice Address - Street 1:270 SHORE RD
Practice Address - Street 2:APT. 30
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4237
Practice Address - Country:US
Practice Address - Phone:516-889-4691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0073781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist