Provider Demographics
NPI:1700651676
Name:ITZKOWITZ, DEBRA (LMSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ITZKOWITZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:DEVORAH
Other - Middle Name:
Other - Last Name:GLUCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1 GISELE CT
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-3327
Mailing Address - Country:US
Mailing Address - Phone:502-512-8273
Mailing Address - Fax:
Practice Address - Street 1:13523 78TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3239
Practice Address - Country:US
Practice Address - Phone:201-688-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06823000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker